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NPI Code Detail

MEDICARE: SALLY WILSON RPH

MEDICARE: SALLY WILSON RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS24455FL

General Provider Information

NPI Number : 1093354847
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLY WILSON RPH
Provider Business Mailing Address
First Line : 210 HIBRITEN WAY
Second Line :
City : LAKELAND
State : FL
Zip : 33803-2224
Country : US
Telephone Number : 863-670-7618
Fax Number :
Provider Business Practice Location Address
First Line : 7450 CYPRESS GARDENS BLVD
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33884-6200
Country : US
Telephone Number : 863-318-0252
Fax Number : 863-318-0282
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2019
Last Update Date : 12/26/2019

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Directions to “ SALLY WILSON RPH” Practice Location

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