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1396878526 NPI number — MYRA JOY WILSON-SOUTHERLAND R.PH.

NPI Number: 1396878526
Health Care Provider/Practitioner: MYRA JOY WILSON-SOUTHERLAND R.PH.

Information about “1396878526” NPI (MYRA JOY WILSON-SOUTHERLAND R.PH.) exists in 1396878526 in HTML format HTML  |  1396878526 in plain Text format TXT  |  1396878526 in PDF (Portable Document Format) PDF  |  1396878526 in an XML format XML  formats.

NPI Number : 1396878526 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396878526",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILSON-SOUTHERLAND",
    "FirstName": "MYRA",
    "MiddleName": "JOY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "R.PH.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SOUTHERLAND",
    "OtherFirstName": "JOY",
    "OtherMiddleName": "WILSON",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "R.PH.",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "1100 E WENDOVER AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREENSBORO",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27405-6713",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "336-641-6582",
    "MailingAddressFaxNumber": "336-641-6971",
    "FirstLinePracticeLocationAddress": "1100 E WENDOVER AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GREENSBORO",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27405-6713",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "336-641-6582",
    "PracticeLocationAddressFaxNumber": "336-641-6971",
    "EnumerationDate": "03/14/2007",
    "LastUpdateDate": "07/23/2007",
    "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": "05778",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1835P1200X",
          "TaxonomyName": "Pharmacotherapy Pharmacist",
          "LicenseNumber": "05778",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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