Annie Clara Widemond, C.PH.T.

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

2901-0104-0756-923 Issued in FL

Practice address

1436 State Road 121 South
Macclenny, FL 32063

Phone

(904) 259-5868

Fax

(904) 259-5275

NPI assigned

Oct 6, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447347992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 GRISSHOLM ST",
            "address_2": "P. O. BOX 1192",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320632613",
            "telephone_number": "904-259-6785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 STATE ROAD 121 SOUTH",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "32063",
            "telephone_number": "904-259-5868",
            "fax_number": "904-259-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDEMOND",
        "first_name": "ANNIE",
        "middle_name": "CLARA",
        "name_prefix": "Mrs.",
        "credential": "C.PH.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "FL",
            "license": "2901-0104-0756-923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy Technician in Macclenny, FL
• Providers in Macclenny, FL by specialty
• Pharmacy Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.