Individual
SHAWNA RAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
115 LOCUST ST, ALLEGAN, MI 49010-1301
(269) 673-4188
Mailing address
115 LOCUST ST, ALLEGAN, MI 49010-1301
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
30020979
MI
Other
Enumeration date
11/17/2017
Last updated
11/17/2017
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