Provider Demographics
NPI:1811224066
Name:WILSON, ZELQUAWANA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:ZELQUAWANA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 ROLLING FOG DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3456
Mailing Address - Country:US
Mailing Address - Phone:281-992-2068
Mailing Address - Fax:281-585-2404
Practice Address - Street 1:2830 ROLLING FOG DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3456
Practice Address - Country:US
Practice Address - Phone:281-992-2068
Practice Address - Fax:281-585-2404
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist