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NPI Code Detail

MEDICARE: AMANDA WILSON PHARM D

MEDICARE: AMANDA WILSON PHARM D
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
1183500000XPharmacist055812NY

General Provider Information

NPI Number : 1558647149
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA WILSON PHARM D
Provider Business Mailing Address
First Line : 430 SPENCERPORT RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14606-5219
Country : US
Telephone Number : 585-247-1710
Fax Number :
Provider Business Practice Location Address
First Line : 430 SPENCERPORT RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14606-5219
Country : US
Telephone Number : 585-247-1710
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2011
Last Update Date : 07/21/2022

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