Provider Demographics
NPI:1497124606
Name:WILSHIRE, MEGAN J (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:J
Last Name:WILSHIRE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:C
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3990 RIVERSIDE PARK BLVD
Mailing Address - Street 2:APT 1706
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1054
Mailing Address - Country:US
Mailing Address - Phone:904-993-8505
Mailing Address - Fax:
Practice Address - Street 1:1114 GA HIGHWAY 96
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-2111
Practice Address - Country:US
Practice Address - Phone:478-987-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist