Provider Demographics
NPI:1477890275
Name:ANDERSON, WILLIAM II (ROH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:ANDERSON
Suffix:II
Gender:M
Credentials:ROH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-3541
Mailing Address - Country:US
Mailing Address - Phone:904-824-5625
Mailing Address - Fax:
Practice Address - Street 1:69 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-3541
Practice Address - Country:US
Practice Address - Phone:904-824-5625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18181183500000X
GARPH13138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist