Provider Demographics
NPI:1558964270
Name:WILSON, JOY ELIZABETH (RPH)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:ELIZABETH
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 1:8408 ANCHORAGE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:711 W MILL ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:IN
Practice Address - Zip Code:47356-9302
Practice Address - Country:US
Practice Address - Phone:765-354-4672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016712A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist