MEDICARE: ERIKA WILSON

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
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	48881	TX

General Provider Information

NPI Number	:	1205467743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA WILSON

Provider Business Mailing Address
First Line	:	6511 MAGELLAN MANOR DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-5559
Country	:	US
Telephone Number	:	404-226-0927
Fax Number	:

Provider Business Practice Location Address
First Line	:	10010 CYPRESSWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-3408
Country	:	US
Telephone Number	:	281-807-1056
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2020
Last Update Date	:	02/03/2020

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