Provider Demographics
NPI:1821634296
Name:WILLIAMS-PRICE, ALISSA G
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:G
Last Name:WILLIAMS-PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 OLYMPIC DR
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-3538
Mailing Address - Country:US
Mailing Address - Phone:321-514-7080
Mailing Address - Fax:
Practice Address - Street 1:5 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2840
Practice Address - Country:US
Practice Address - Phone:321-383-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT53347183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician