Basic Information
Provider Information
NPI: 1003139288
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILSON
FirstName: ASHLEY
MiddleName: NICOLE
NamePrefix:  
NameSuffix:  
Credential: PHARMD.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13725 32ND AVE NE APT C236
Address2:  
City: SEATTLE
State: WA
PostalCode: 981254662
CountryCode: US
TelephoneNumber: 2068560831
FaxNumber:  
Practice Location
Address1: 747 BROADWAY
Address2: ATTN: INPATIENT PHARMACY
City: SEATTLE
State: WA
PostalCode: 981224379
CountryCode: US
TelephoneNumber: 2062156283
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/02/2010
LastUpdateDate: 03/02/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XPH60001545WAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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