Provider Demographics
NPI:1275144909
Name:WILSON, JULIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
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 1:5301 CHICAGO AVE APT 1207
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-2097
Mailing Address - Country:US
Mailing Address - Phone:713-292-4043
Mailing Address - Fax:
Practice Address - Street 1:6420 82ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-0804
Practice Address - Country:US
Practice Address - Phone:806-783-9041
Practice Address - Fax:806-783-9064
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist