Provider Demographics
NPI:1275172330
Name:NELSON, MAKAYLA WILES (PHARMD, BCACP)
Entity Type:Individual
Prefix:DR
First Name:MAKAYLA
Middle Name:WILES
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:DR
Other - First Name:MAKAYLA
Other - Middle Name:DAWN
Other - Last Name:WILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:720 WIDENER CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-4004
Mailing Address - Country:US
Mailing Address - Phone:270-604-2150
Mailing Address - Fax:
Practice Address - Street 1:135 E MAXWELL ST STE 401
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2617
Practice Address - Country:US
Practice Address - Phone:859-323-2663
Practice Address - Fax:859-218-7690
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020720183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist