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1114527504 NPI number — SHAUNA JO WILSON PHARM. D

NPI Number: 1114527504
Health Care Provider/Practitioner: SHAUNA JO WILSON PHARM. D

Information about “1114527504” NPI (SHAUNA JO WILSON PHARM. D) exists in 1114527504 in HTML format HTML  |  1114527504 in plain Text format TXT  |  1114527504 in PDF (Portable Document Format) PDF  |  1114527504 in an XML format XML  formats.

NPI Number : 1114527504 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114527504",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILSON",
    "FirstName": "SHAUNA",
    "MiddleName": "JO",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHARM. D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "128 PRICE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOT SPRINGS",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "71913-2527",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "501-693-4111",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1544 MALVERN AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOT SPRINGS",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "71901-6535",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "501-262-7519",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/27/2020",
    "LastUpdateDate": "10/27/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "PD14980",
        "LicenseNumberStateCode": "AR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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