Provider Demographics
NPI:1427673631
Name:WILSON BROWNFIELD, CASSANDRA MARIE
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MARIE
Last Name:WILSON BROWNFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:MARIE
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:812 HODAPP AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-2905
Mailing Address - Country:US
Mailing Address - Phone:330-204-3676
Mailing Address - Fax:
Practice Address - Street 1:2710 SALEM AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2730
Practice Address - Country:US
Practice Address - Phone:937-277-6022
Practice Address - Fax:937-277-2629
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03136265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist