Provider Demographics
NPI:1124028659
Name:WILLMANN, PATIRICA A (MS RPH BCOP)
Entity Type:Individual
Prefix:MS
First Name:PATIRICA
Middle Name:A
Last Name:WILLMANN
Suffix:
Gender:F
Credentials:MS RPH BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 STEVE REYNOLDS BLVD.
Mailing Address - Street 2:KAISER PERMANENTE
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:404-365-0966
Mailing Address - Fax:912-819-8468
Practice Address - Street 1:5353 REYNOLDS ST
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6015
Practice Address - Country:US
Practice Address - Phone:912-819-8147
Practice Address - Fax:912-819-8468
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03213959183500000X
GA0150771835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
No183500000XPharmacy Service ProvidersPharmacist