Provider Demographics
NPI:1568734481
Name:WILSON, YOLANDA EDITH (RPH)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:EDITH
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 1:774 S SHELMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7625
Mailing Address - Country:US
Mailing Address - Phone:843-388-1548
Mailing Address - Fax:843-388-1549
Practice Address - Street 1:774 S SHELMORE BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7625
Practice Address - Country:US
Practice Address - Phone:843-388-1548
Practice Address - Fax:843-388-1549
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist