Provider Demographics
NPI:1629298930
Name:WILLIAMS, DEBRA KAYE (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAYE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6099 SPOTTED FAWN CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5512
Mailing Address - Country:US
Mailing Address - Phone:239-482-1606
Mailing Address - Fax:239-482-1606
Practice Address - Street 1:12995 S CLEVELAND AVE.
Practice Address - Street 2:SUITE 184
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7703
Practice Address - Country:US
Practice Address - Phone:239-939-2201
Practice Address - Fax:239-939-6910
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 16183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist