MEDICARE: LISA WILCOX

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	183500000X	Pharmacist	RP039667R	PA
2	183500000X	Pharmacist	03217924	OH

General Provider Information

NPI Number	:	1700269495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA WILCOX

Provider Business Mailing Address
First Line	:	353 E 6TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16507-1609
Country	:	US
Telephone Number	:	814-455-2910
Fax Number	:

Provider Business Practice Location Address
First Line	:	353 E 6TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16507-1609
Country	:	US
Telephone Number	:	814-455-2910
Fax Number	:

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

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	06/30/2015

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Directions to “ LISA WILCOX ” Practice Location

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