Provider Demographics
NPI:1407139520
Name:KING-WILSON, ELICIA D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELICIA
Middle Name:D
Last Name:KING-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 1:1920 ALOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3207
Mailing Address - Country:US
Mailing Address - Phone:407-628-1899
Mailing Address - Fax:
Practice Address - Street 1:1920 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3207
Practice Address - Country:US
Practice Address - Phone:407-628-1899
Practice Address - Fax:407-628-8842
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 40267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist