Provider Demographics
NPI:1164705166
Name:WILSON, MEREDITH S (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:S
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9907 MIKE LN
Mailing Address - Street 2:
Mailing Address - City:DORA
Mailing Address - State:AL
Mailing Address - Zip Code:35062-1629
Mailing Address - Country:US
Mailing Address - Phone:205-789-9250
Mailing Address - Fax:
Practice Address - Street 1:879 HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:SUMITON
Practice Address - State:AL
Practice Address - Zip Code:35148-3416
Practice Address - Country:US
Practice Address - Phone:205-648-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist