Provider Demographics
NPI:1508097460
Name:WILSON, LAUREN ELIZABETH (PHARM D)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4506
Mailing Address - Country:US
Mailing Address - Phone:830-792-6557
Mailing Address - Fax:830-792-5411
Practice Address - Street 1:624 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4506
Practice Address - Country:US
Practice Address - Phone:830-792-6557
Practice Address - Fax:830-792-5411
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist