Provider Demographics
NPI:1538490610
Name:WILSON, CARRIE-ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARRIE-ANNE
Middle Name:
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 1:1103 WALDEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2180
Mailing Address - Country:US
Mailing Address - Phone:706-319-6788
Mailing Address - Fax:
Practice Address - Street 1:5204 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-1606
Practice Address - Country:US
Practice Address - Phone:912-966-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH023089OtherGEORGIA BOARD OF PHARMACY