MEDICARE: MS. JANET LEIGH WILMS RPH, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202011274	VA
2	183500000X	Pharmacist	14469	MD
3	183500000X	Pharmacist	03219711	OH

General Provider Information

NPI Number	:	1033367990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANET LEIGH WILMS RPH, MBA

Provider Business Mailing Address
First Line	:	2505 BELMONT STAKES DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-8130
Country	:	US
Telephone Number	:	757-619-3775
Fax Number	:	757-471-4156

Provider Business Practice Location Address
First Line	:	2505 BELMONT STAKES DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-8130
Country	:	US
Telephone Number	:	757-619-3775
Fax Number	:	757-471-4156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	09/04/2008

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