Provider Demographics
NPI:1053559138
Name:WILSON, TONI MARIE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:TONI
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N LOYALSOCK AVE
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-1065
Mailing Address - Country:US
Mailing Address - Phone:570-368-5454
Mailing Address - Fax:570-368-5466
Practice Address - Street 1:1015 N LOYALSOCK AVE
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-1065
Practice Address - Country:US
Practice Address - Phone:570-368-5454
Practice Address - Fax:570-368-5466
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP046444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist