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NPI Code Detail

MEDICARE: MARIA NICOLE WILSON

MEDICARE: MARIA NICOLE WILSON
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
1183500000XPharmacist18840OK

General Provider Information

NPI Number : 1366043739
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA NICOLE WILSON
Provider Business Mailing Address
First Line : 1900 W MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-6504
Country : US
Telephone Number : 405-748-6524
Fax Number :
Provider Business Practice Location Address
First Line : 1900 W MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-6504
Country : US
Telephone Number : 405-748-6524
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2020
Last Update Date : 11/03/2020

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Directions to “ MARIA NICOLE WILSON ” Practice Location

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