Provider Demographics
NPI:1821064247
Name:WOLSONCROFT, LEA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:MARIE
Last Name:WOLSONCROFT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4524 SOUTHLAKE PKWY STE 34
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3607
Mailing Address - Country:US
Mailing Address - Phone:205-593-4223
Mailing Address - Fax:205-313-5791
Practice Address - Street 1:4524 SOUTHLAKE PKWY STE 34
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3607
Practice Address - Country:US
Practice Address - Phone:205-593-4223
Practice Address - Fax:205-593-4573
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12774183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1821064247Medicaid