Individual
MRS. ANNIE CLARA WIDEMOND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.PH.T.
Contact information
Practice address
1436 STATE ROAD 121 SOUTH, MACCLENNY, FL 32063
(904) 259-5868
(904) 259-5275
Mailing address
507 GRISSHOLM ST, P. O. BOX 1192, MACCLENNY, FL 32063-2613
(904) 259-6785
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
2901-0104-0756-923
FL
Other
Enumeration date
10/06/2006
Last updated
07/08/2007
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