Provider Demographics
NPI:1952473217
Name:WILLIAMS, ANGIE BEACH (RPH)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:BEACH
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 1:1031 BETH PAGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-7307
Mailing Address - Country:US
Mailing Address - Phone:850-997-6168
Mailing Address - Fax:
Practice Address - Street 1:1245 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-1633
Practice Address - Country:US
Practice Address - Phone:850-997-9632
Practice Address - Fax:850-997-3541
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist