Provider Demographics
NPI:1700884368
Name:WILSON, NOREEN A (RPH)
Entity type:Individual
Prefix:
First Name:NOREEN
Middle Name:A
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 1:1211 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1829
Mailing Address - Country:US
Mailing Address - Phone:216-381-6787
Mailing Address - Fax:216-761-2859
Practice Address - Street 1:13951 TERRACE RD
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4308
Practice Address - Country:US
Practice Address - Phone:216-761-6999
Practice Address - Fax:216-761-2859
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03216574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist