Provider Demographics
NPI:1902151475
Name:WRIGHT, WILDA L (PHARMD)
Entity Type:Individual
Prefix:
First Name:WILDA
Middle Name:L
Last Name:WRIGHT
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 1:1542 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3508
Mailing Address - Country:US
Mailing Address - Phone:310-994-6731
Mailing Address - Fax:818-243-1918
Practice Address - Street 1:109 N CHEVY CHASE DR
Practice Address - Street 2:#207
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-5840
Practice Address - Country:US
Practice Address - Phone:310-994-6731
Practice Address - Fax:818-243-1918
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41590183500000X
NV9068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist