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General NPI Number Information
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NPI Number | 1407210727
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Entity Type | Individual
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Provider Name | REGINA MARSHALL WILSON-HANNA PHARM D
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Gender | Female
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 1641 WORTHINGTON RD STE 120
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6706
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Country | US
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Telephone | 561-615-6011
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Fax |
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Provider Business Mailing Address
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Address Line | 954 NW 205TH ST
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City | MIAMI
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State | FL
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Zip | 33169-2373
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Country | US
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Telephone | 786-201-1467
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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 | PS20135
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License Number State | FL
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