Basic Information
| Provider Information | |||||||||
| NPI: | 1124028659 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLMANN | ||||||||
| FirstName: | PATIRICA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS RPH BCOP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3650 STEVE REYNOLDS BLVD. | ||||||||
| Address2: | KAISER PERMANENTE | ||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043650966 | ||||||||
| FaxNumber: | 9128198468 | ||||||||
| Practice Location | |||||||||
| Address1: | 5353 REYNOLDS ST | ||||||||
| Address2: | PHARMACY DEPT | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314056015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128198147 | ||||||||
| FaxNumber: | 9128198468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2005 | ||||||||
| LastUpdateDate: | 08/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 03213959 | OH | N | Pharmacy Service Providers | Pharmacist | 1835X0200X | 015077 | GA | Y | Pharmacy Service Providers | Pharmacist | Oncology |
No ID Information.