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General NPI Number Information
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NPI Number | 1346451515
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Entity Type | Individual
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Provider Name | JENIFER L WILSON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 05/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 110 W PLATTE AVE
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City | FORT MORGAN
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State | CO
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Zip | 80701-2144
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Country | US
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Telephone | 970-867-9201
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Fax | 970-867-5228
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Provider Business Mailing Address
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Address Line | 929 LAKE ST
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City | FORT MORGAN
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State | CO
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Zip | 80701-3028
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Country | US
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Telephone | 970-867-4979
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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 | 16954
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License Number State | CO
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