Provider Demographics
NPI:1558680744
Name:WILSON, JANEANE N (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JANEANE
Middle Name:N
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 1:114 S HURON AVE
Mailing Address - Street 2:
Mailing Address - City:HARBOR BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:48441-1201
Mailing Address - Country:US
Mailing Address - Phone:989-315-8605
Mailing Address - Fax:989-479-3242
Practice Address - Street 1:114 S HURON AVE
Practice Address - Street 2:
Practice Address - City:HARBOR BEACH
Practice Address - State:MI
Practice Address - Zip Code:48441-1201
Practice Address - Country:US
Practice Address - Phone:989-315-8605
Practice Address - Fax:989-479-3242
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist