Provider Demographics
NPI:1568058360
Name:WILSON, ERIN SLEAN
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:SLEAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GILMER AVE
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1206
Mailing Address - Country:US
Mailing Address - Phone:334-283-3637
Mailing Address - Fax:334-252-0536
Practice Address - Street 1:10 GILMER AVE
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1206
Practice Address - Country:US
Practice Address - Phone:334-283-3637
Practice Address - Fax:334-252-0536
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT30367183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician