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General NPI Number Information
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NPI Number | 1306112115
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Entity Type | Individual
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Provider Name | STACIE WILSON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 1019 GRANDIFLORA DR
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City | LELAND
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State | NC
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Zip | 28451-7453
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Country | US
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Telephone | 910-371-0233
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 GRANDIFLORA DR
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City | LELAND
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State | NC
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Zip | 28451-7453
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Country | US
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Telephone |
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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 | PS44006
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH024755
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 22305
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License Number State | NC
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