Provider Demographics
NPI:1831640978
Name:WILSON, BRIANNA MIJAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MIJAY
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 1:200 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-3120
Mailing Address - Country:US
Mailing Address - Phone:337-828-4493
Mailing Address - Fax:337-828-4493
Practice Address - Street 1:200 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-3120
Practice Address - Country:US
Practice Address - Phone:337-828-4493
Practice Address - Fax:337-828-4493
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist