MEDICARE: QUIANA SHEMON 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
1	183500000X	Pharmacist	PS41415	FL

General Provider Information

NPI Number	:	1760764625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUIANA SHEMON WILSON PHARMD

Provider Business Mailing Address
First Line	:	866 DUNN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4803
Country	:	US
Telephone Number	:	904-910-6497
Fax Number	:

Provider Business Practice Location Address
First Line	:	866 DUNN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4803
Country	:	US
Telephone Number	:	904-751-3530
Fax Number	:	904-751-4528

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

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	12/24/2022

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