Provider Demographics
NPI:1083207757
Name:WILSON, ANNITA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANNITA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:ANNITA
Other - Middle Name:
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:295 E 244TH ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1432
Mailing Address - Country:US
Mailing Address - Phone:216-394-3464
Mailing Address - Fax:
Practice Address - Street 1:36195 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4410
Practice Address - Country:US
Practice Address - Phone:440-975-1983
Practice Address - Fax:440-520-7148
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist