Provider Demographics
NPI:1437285087
Name:WERNER, FRED WILLIAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:WILLIAM
Last Name:WERNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 WOODMERE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405
Mailing Address - Country:US
Mailing Address - Phone:850-625-8988
Mailing Address - Fax:850-271-9379
Practice Address - Street 1:1812 HWY 77 SOUTH
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444
Practice Address - Country:US
Practice Address - Phone:850-271-8016
Practice Address - Fax:850-271-9379
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS15547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist