Provider Demographics
NPI:1033527478
Name:WILSON, MARYLYN E (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARYLYN
Middle Name:E
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18551 N 83RD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0501
Mailing Address - Country:US
Mailing Address - Phone:623-825-7978
Mailing Address - Fax:623-825-9680
Practice Address - Street 1:18551 N 83RD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0501
Practice Address - Country:US
Practice Address - Phone:623-825-7978
Practice Address - Fax:623-825-9680
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist