Provider Demographics
NPI:1639462187
Name:WILSON, BARBARA ELLEN (RPH,MBA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ELLEN
Last Name:WILSON
Suffix:
Gender:F
Credentials:RPH,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 HODGE RD
Mailing Address - Street 2:
Mailing Address - City:COFFEEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36524-6707
Mailing Address - Country:US
Mailing Address - Phone:251-276-0817
Mailing Address - Fax:334-636-4495
Practice Address - Street 1:33151 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-1634
Practice Address - Country:US
Practice Address - Phone:334-636-4616
Practice Address - Fax:334-636-4495
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist