Provider Demographics
NPI:1558669697
Name:WILSON, JULIA R (RPH)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:R
Last Name:WILSON
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 1:1000 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2505
Mailing Address - Country:US
Mailing Address - Phone:803-773-7302
Mailing Address - Fax:803-775-1468
Practice Address - Street 1:1000 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2505
Practice Address - Country:US
Practice Address - Phone:803-773-7302
Practice Address - Fax:803-775-1468
Is Sole Proprietor?:No
Enumeration Date:2011-03-13
Last Update Date:2011-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist