Provider Demographics
NPI:1447636592
Name:WILSON, KIERRA MONE'T (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIERRA
Middle Name:MONE'T
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 1:15205 PLANE TREE CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3020
Mailing Address - Country:US
Mailing Address - Phone:216-258-5818
Mailing Address - Fax:
Practice Address - Street 1:2300 4TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20059-5505
Practice Address - Country:US
Practice Address - Phone:202-806-4207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD271821835P0018X
OH03335013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist