Provider Demographics
NPI:1710259262
Name:WILLIAMS, BRIAN A (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
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 1:1680 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1723
Mailing Address - Country:US
Mailing Address - Phone:954-465-7088
Mailing Address - Fax:954-467-8768
Practice Address - Street 1:1680 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1723
Practice Address - Country:US
Practice Address - Phone:954-465-7088
Practice Address - Fax:954-467-8768
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS36098OtherPHARMACY LICENSE NUMBER