Provider Demographics
NPI:1629353123
Name:WIGELSWORTH, ERNESTINE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:ERNESTINE
Middle Name:
Last Name:WIGELSWORTH
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13740 BEACH BLVD.
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1208
Mailing Address - Country:US
Mailing Address - Phone:904-248-4364
Mailing Address - Fax:
Practice Address - Street 1:13740 BEACH BLVD.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1208
Practice Address - Country:US
Practice Address - Phone:904-248-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist