Provider Demographics
NPI:1225375157
Name:WILSON, KRISTINA E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:E
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 1:233 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MA
Mailing Address - Zip Code:01469-1033
Mailing Address - Country:US
Mailing Address - Phone:978-597-2392
Mailing Address - Fax:978-597-8731
Practice Address - Street 1:233 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:MA
Practice Address - Zip Code:01469-1033
Practice Address - Country:US
Practice Address - Phone:978-597-2392
Practice Address - Fax:978-597-8731
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist