Healthcare Provider Details

I. General information

NPI: 1609988807
Provider Name (Legal Business Name): ERIKA DAWN WILSON PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR UNIT MEDDAC
FT CARSON CO
80913-4604
US

IV. Provider business mailing address

1650 COCHRANE CIRCLE
FORT CARSON CO
80913
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7391
  • Fax: 719-526-7377
Mailing address:
  • Phone: 505-306-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0017739
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: