Provider Demographics
NPI:1447576855
Name:WILSON, SUMMER BLAKENEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:BLAKENEY
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 1:1128 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-1739
Mailing Address - Country:US
Mailing Address - Phone:205-932-5400
Mailing Address - Fax:205-932-5401
Practice Address - Street 1:1128 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1739
Practice Address - Country:US
Practice Address - Phone:205-932-5400
Practice Address - Fax:205-932-5401
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist