Healthcare Provider Details

I. General information

NPI: 1700884368
Provider Name (Legal Business Name): NOREEN A WILSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13951 TERRACE RD
EAST CLEVELAND OH
44112-4308
US

IV. Provider business mailing address

1211 OXFORD RD
CLEVELAND HTS OH
44121-1829
US

V. Phone/Fax

Practice location:
  • Phone: 216-761-6999
  • Fax: 216-761-2859
Mailing address:
  • Phone: 216-381-6787
  • Fax: 216-761-2859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03216574
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: