Provider Demographics
NPI:1740880129
Name:WAKEFIELD, MONIQUE LEGER (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LEGER
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 GALLERY WAY
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-8399
Mailing Address - Country:US
Mailing Address - Phone:214-995-8916
Mailing Address - Fax:
Practice Address - Street 1:500 RICHLAND BLVD
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-7275
Practice Address - Country:US
Practice Address - Phone:972-347-9572
Practice Address - Fax:972-347-9591
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.016402183500000X
TX36419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist