Provider Demographics
NPI:1154618833
Name:WILGA, AMANDA ALICIA (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ALICIA
Last Name:WILGA
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 1:8 DUNHAM POND RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1438
Mailing Address - Country:US
Mailing Address - Phone:508-361-1522
Mailing Address - Fax:
Practice Address - Street 1:377 CHAUNCY ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1169
Practice Address - Country:US
Practice Address - Phone:508-377-9455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist