Provider Demographics
NPI:1700176658
Name:WILSON, ROBBIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ROBBIE
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 1:185 STRANDHILL RD
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2249
Mailing Address - Country:US
Mailing Address - Phone:404-401-5078
Mailing Address - Fax:
Practice Address - Street 1:305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:GA
Practice Address - Zip Code:31816-1656
Practice Address - Country:US
Practice Address - Phone:706-846-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016897183500000X
FL27397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist