Provider Demographics
NPI:1225470529
Name:WILDER, AISHA K (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:AISHA
Middle Name:K
Last Name:WILDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:AISHA
Other - Middle Name:KAI
Other - Last Name:AJIBOYE- WILDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:928 SADDLE CREEK RUN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-7308
Mailing Address - Country:US
Mailing Address - Phone:850-228-1248
Mailing Address - Fax:
Practice Address - Street 1:6680 THOMASVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-3836
Practice Address - Country:US
Practice Address - Phone:850-877-7603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-27
Last Update Date:2013-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist