Provider Demographics
NPI:1023798923
Name:WILSTON, AMANDA C
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:WILSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-2523
Mailing Address - Country:US
Mailing Address - Phone:717-245-2541
Mailing Address - Fax:
Practice Address - Street 1:351 E HIGH ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2523
Practice Address - Country:US
Practice Address - Phone:717-245-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30239237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist