Provider Demographics
NPI:1629457270
Name:WILL-CARE PHARMACY LLC
Entity Type:Organization
Organization Name:WILL-CARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANCELOT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-253-8100
Mailing Address - Street 1:9867 E FERN ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5413
Mailing Address - Country:US
Mailing Address - Phone:305-253-8100
Mailing Address - Fax:305-712-4499
Practice Address - Street 1:9867 E FERN ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5413
Practice Address - Country:US
Practice Address - Phone:305-253-8100
Practice Address - Fax:305-712-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7414020001Medicare NSC