Provider Demographics
NPI:1912702416
Name:RHODEN, WILLIAM R JR (PHARMACIST)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:RHODEN
Suffix:JR
Gender:
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6164 HARRY REWIS RD
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-3738
Mailing Address - Country:US
Mailing Address - Phone:904-318-5804
Mailing Address - Fax:
Practice Address - Street 1:900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-1360
Practice Address - Country:US
Practice Address - Phone:386-496-1685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist