Provider Demographics
NPI:1609261502
Name:WINGLER, MARY JOYCE
Entity Type:Individual
Prefix:
First Name:MARY JOYCE
Middle Name:
Last Name:WINGLER
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 1:1100 STONEGATE DR
Mailing Address - Street 2:LOT 131
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-1600
Mailing Address - Country:US
Mailing Address - Phone:256-496-0332
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST150601835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist