MEDICARE: DAVID L WILLIFORD RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	014514	GA

General Provider Information

NPI Number	:	1922218296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L WILLIFORD RPH

Provider Business Mailing Address
First Line	:	116 HIGHLAND DR
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-5727
Country	:	US
Telephone Number	:	912-826-5422
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 GOSHEN RD
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-5545
Country	:	US
Telephone Number	:	912-826-6612
Fax Number	:	912-826-6017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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Directions to “ DAVID L WILLIFORD RPH” Practice Location

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