Provider Demographics
NPI:1457679003
Name:WILSON, JANICE COOK (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:COOK
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 1:1505 E RIO GRANDE ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6220
Mailing Address - Country:US
Mailing Address - Phone:361-572-8001
Mailing Address - Fax:361-574-9844
Practice Address - Street 1:1505 E RIO GRANDE ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6220
Practice Address - Country:US
Practice Address - Phone:361-572-8001
Practice Address - Fax:361-574-9844
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist