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NPI Code Detail

MEDICARE: AMANDA WILSON PHARMD

MEDICARE: AMANDA WILSON PHARMD
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
1183500000XPharmacist16329-40WI

General Provider Information

NPI Number : 1720365505
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA WILSON PHARMD
Provider Business Mailing Address
First Line : 1001 CORMIER RD
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-4404
Country : US
Telephone Number : 920-499-2608
Fax Number : 920-593-9512
Provider Business Practice Location Address
First Line : 1001 CORMIER RD
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-4404
Country : US
Telephone Number : 920-499-2608
Fax Number : 920-593-9512
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2011
Last Update Date : 01/12/2016

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Directions to “ AMANDA WILSON PHARMD” Practice Location

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