Provider Demographics
NPI:1679331888
Name:WILLIAMS, PHYLICIA LASHAE (PHARM D)
Entity Type:Individual
Prefix:
First Name:PHYLICIA
Middle Name:LASHAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 RACETRACK RD NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3924
Mailing Address - Country:US
Mailing Address - Phone:850-315-0474
Mailing Address - Fax:
Practice Address - Street 1:434 RACETRACK RD
Practice Address - Street 2:
Practice Address - City:FORT WALTON
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-315-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist