Basic Information
| Provider Information | |||||||||
| NPI: | 1003139288 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | PHARMD. | ||||||||
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| 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 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2010 | ||||||||
| LastUpdateDate: | 03/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH60001545 | WA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.