Provider Demographics
NPI:1720315153
Name:WILLIAMS PHARMACIES LLC
Entity Type:Organization
Organization Name:WILLIAMS PHARMACIES LLC
Other - Org Name:LIBRA SUN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARKO
Authorized Official - Middle Name:
Authorized Official - Last Name:JARIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-616-5675
Mailing Address - Street 1:141 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-1623
Mailing Address - Country:US
Mailing Address - Phone:954-616-5675
Mailing Address - Fax:954-626-0297
Practice Address - Street 1:141 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-1623
Practice Address - Country:US
Practice Address - Phone:954-616-5675
Practice Address - Fax:954-626-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH237513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123167OtherPK
FL001584700Medicaid