Provider Demographics
NPI:1902401912
Name:WILSON, MELANIE (RPH)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
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 1:2102 ELDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-1812
Mailing Address - Country:US
Mailing Address - Phone:281-242-2890
Mailing Address - Fax:
Practice Address - Street 1:2102 ELDRIDGE RD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-1812
Practice Address - Country:US
Practice Address - Phone:281-242-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist