Provider Demographics
NPI:1023708278
Name:WILSON, STELLA LURENE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STELLA
Middle Name:LURENE
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 1:129 BARRIER ISLE DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-2243
Mailing Address - Country:US
Mailing Address - Phone:417-766-5629
Mailing Address - Fax:
Practice Address - Street 1:129 BARRIER ISLE DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-2243
Practice Address - Country:US
Practice Address - Phone:417-766-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50259183500000X
MO2002024557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist