Healthcare Provider Details

I. General information

NPI: 1942971825
Provider Name (Legal Business Name): RACHAEL WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 LAWNDALE DR
GREENSBORO NC
27455-3001
US

IV. Provider business mailing address

3701 COTSWOLD TER UNIT 3A
GREENSBORO NC
27410-8905
US

V. Phone/Fax

Practice location:
  • Phone: 336-540-1344
  • Fax:
Mailing address:
  • Phone: 336-681-4880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30892
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: