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General NPI Number Information
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NPI Number | 1083207757
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Entity Type | Individual
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Provider Name | ANNITA WILSON R.PH.
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Gender | Female
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Dates
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Enumeration Date | 02/14/2021
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Last Update Date | 02/14/2021
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Provider Practice Location Address
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Address Line | 36195 EUCLID AVE
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City | WILLOUGHBY
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State | OH
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Zip | 44094-4410
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Country | US
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Telephone | 440-975-1983
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Fax | 440-520-7148
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Provider Business Mailing Address
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Address Line | 295 E 244TH ST
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City | EUCLID
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State | OH
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Zip | 44123-1432
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Country | US
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Telephone | 216-394-3464
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03223058
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License Number State | OH
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