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General NPI Number Information
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NPI Number | 1396155727
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Entity Type | Individual
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Provider Name | GERALD WILDER RPH
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Gender | Male
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 28800 TELEGRAPH RD
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1950
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Country | US
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Telephone | 248-304-9500
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Fax | 248-304-9565
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Provider Business Mailing Address
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Address Line | 28800 TELEGRAPH RD
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1950
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 411200
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License Number State | MI
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