Provider Demographics
NPI:1851812077
Name:WILDER, GRETCHEN SCHMIDT (PHARMD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:SCHMIDT
Last Name:WILDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:GAIL AMY
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:91 TRAVIS CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3315
Mailing Address - Country:US
Mailing Address - Phone:301-351-9423
Mailing Address - Fax:
Practice Address - Street 1:18169 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1482
Practice Address - Country:US
Practice Address - Phone:301-260-1401
Practice Address - Fax:301-260-1371
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist