Provider Demographics
NPI:1225234560
Name:WILSON, NANCY LOUISE (MS, RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LOUISE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 STURBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-1632
Mailing Address - Country:US
Mailing Address - Phone:508-385-4534
Mailing Address - Fax:
Practice Address - Street 1:976 ROUTE 28
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-5644
Practice Address - Country:US
Practice Address - Phone:508-398-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist