Provider Demographics
NPI:1851626253
Name:WILSON, DONNA MICHELLE (RPH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MICHELLE
Last Name:WILSON
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 1:12530 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7934
Mailing Address - Country:US
Mailing Address - Phone:919-773-9772
Mailing Address - Fax:919-773-9778
Practice Address - Street 1:12530 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7934
Practice Address - Country:US
Practice Address - Phone:919-773-9772
Practice Address - Fax:919-773-9778
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist