Individual
CHRISTINE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 414-2000
Mailing address
1115 SE 164TH AVE, DEPT. 358, VANCOUVER, WA 98683-9324
(360) 729-1462
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH00061650
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2071531
—
WA
05
—
500718524
—
OR
Enumeration date
08/31/2012
Last updated
02/16/2017
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