Provider Demographics
NPI:1467751735
Name:ALSTON, WILMA D (RPH)
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:D
Last Name:ALSTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2552 DILWORTH ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-1961
Mailing Address - Country:US
Mailing Address - Phone:336-748-9228
Mailing Address - Fax:336-631-5428
Practice Address - Street 1:401 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2643
Practice Address - Country:US
Practice Address - Phone:336-993-2195
Practice Address - Fax:336-996-2184
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist