Provider Demographics
NPI:1568761682
Name:WILSON, MELODIE ABEL (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:MELODIE
Middle Name:ABEL
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29697
Mailing Address - Country:US
Mailing Address - Phone:864-847-9071
Mailing Address - Fax:864-847-9656
Practice Address - Street 1:201 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:SC
Practice Address - Zip Code:29697-1910
Practice Address - Country:US
Practice Address - Phone:864-847-9071
Practice Address - Fax:864-847-9656
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist