Doctor Name: | MRS. ANNIE CLARA WIDEMOND |
NPI Number: | 1447347992 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | C.PH.T. |
License Number: | 2901-0104-0756-923 |
Business Practice Address: | 1436 State Road 121 South Macclenny, FL - 32063 |
Business Phone Number: | 9042595868 |
Business Fax Number: | 9042595275 |
Mailing Address: | 507 Grissholm St, P. O. Box 1192 MACCLENNY |
State: | FL |
Postal Code: | 320632613 |
Phone Number: | 9042596785 |
Fax Number: | |
NPI Enumeration Date: | 10/06/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 183700000X |
License Number: | 2901-0104-0756-923 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Pharmacy Service Providers |
Taxonomy Classification: | Pharmacy Technician |
Taxonomy Specialization: | |
Taxonomy Definition: | A person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professional judgment of a pharmacist. |