Provider Demographics
NPI:1710068648
Name:WILLIAMS, PENNY T (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:T
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 1:780 SE BAYA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-5403
Mailing Address - Country:US
Mailing Address - Phone:386-755-6677
Mailing Address - Fax:386-755-4133
Practice Address - Street 1:780 SE BAYA DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5403
Practice Address - Country:US
Practice Address - Phone:386-755-6677
Practice Address - Fax:386-755-4133
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS26359OtherPHARMACY LICENSE