Provider Demographics
NPI:1174965586
Name:WILHELM, ELISE SONJA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:SONJA
Last Name:WILHELM
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 1:1 ELY PARK BLVD
Mailing Address - Street 2:E-3
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1480
Mailing Address - Country:US
Mailing Address - Phone:607-434-6005
Mailing Address - Fax:
Practice Address - Street 1:3112 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2038
Practice Address - Country:US
Practice Address - Phone:607-729-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20058207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist