Provider Demographics
NPI:1871963587
Name:MAIDEN, WILLIAM CHARLES (PHARMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHARLES
Last Name:MAIDEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16980 ALICO MISSION WAY
Mailing Address - Street 2:UNIT 403
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4851
Mailing Address - Country:US
Mailing Address - Phone:304-266-8895
Mailing Address - Fax:239-489-3496
Practice Address - Street 1:16980 ALICO MISSION WAY
Practice Address - Street 2:STE 403
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4851
Practice Address - Country:US
Practice Address - Phone:239-489-0729
Practice Address - Fax:239-489-3496
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS53863OtherSTATE-ISSUED