Provider Demographics
NPI:1922218296
Name:WILLIFORD, DAVID L (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:WILLIFORD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5727
Mailing Address - Country:US
Mailing Address - Phone:912-826-5422
Mailing Address - Fax:
Practice Address - Street 1:100 GOSHEN RD
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5545
Practice Address - Country:US
Practice Address - Phone:912-826-6612
Practice Address - Fax:912-826-6017
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist