Provider Demographics
NPI:1992089957
Name:WILLMAN, JASON ERIC (RPH)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ERIC
Last Name:WILLMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 ALTON RD
Mailing Address - Street 2:APT # 652
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3301
Mailing Address - Country:US
Mailing Address - Phone:415-728-7251
Mailing Address - Fax:
Practice Address - Street 1:1845 ALTON RD
Practice Address - Street 2:WALGREENS
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-1504
Practice Address - Country:US
Practice Address - Phone:305-531-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist