Provider Demographics
NPI:1689845836
Name:WILDMAN, MEGAN HAUCK (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:HAUCK
Last Name:WILDMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:HAUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:3480 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1700
Mailing Address - Country:US
Mailing Address - Phone:334-819-4500
Mailing Address - Fax:
Practice Address - Street 1:3480 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1700
Practice Address - Country:US
Practice Address - Phone:334-819-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03225071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist