Provider Demographics
NPI:1225699143
Name:WILLIAMS, TANYA LESHEA (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LESHEA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-3400
Mailing Address - Country:US
Mailing Address - Phone:386-255-5569
Mailing Address - Fax:
Practice Address - Street 1:240 N FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3400
Practice Address - Country:US
Practice Address - Phone:386-255-5569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS78761835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592897172Medicaid