Provider Demographics
NPI:1992024822
Name:WILCOX, MICHELLE DIANE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DIANE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:DIANE
Other - Last Name:SACKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:714 GREENFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CASTALIAN SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37031-4741
Mailing Address - Country:US
Mailing Address - Phone:727-709-3171
Mailing Address - Fax:
Practice Address - Street 1:4220 HARDING PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2005
Practice Address - Country:US
Practice Address - Phone:615-222-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37236183500000X, 1835P0018X
FLPS454451835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist