Provider Demographics
NPI:1780218693
Name:WILSON, CHARLOTTE (PHARMD)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:
Other - Last Name:TAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2950 S HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:47424-5583
Mailing Address - Country:US
Mailing Address - Phone:540-623-5151
Mailing Address - Fax:
Practice Address - Street 1:1494 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:IN
Practice Address - Zip Code:47446-9493
Practice Address - Country:US
Practice Address - Phone:812-865-3266
Practice Address - Fax:812-849-2832
Is Sole Proprietor?:No
Enumeration Date:2020-02-29
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026520A1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care