Wilson'S Pharmacy, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

WILSON'S PHARMACY, INC.

Practice address

101 Pine Ave E
Wiggins, MS 39577-2752

Phone

(601) 928-4446

Fax

(601) 928-4844

NPI assigned

Oct 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Simon P. Wilson III, R.PH.

Title

Co-Owner

Phone

(601) 928-4446

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549324800000",
    "number": "1053401067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PINE AVE E",
            "city": "WIGGINS",
            "state": "MS",
            "postal_code": "395772752",
            "telephone_number": "601-928-4446",
            "fax_number": "601-928-4844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PINE AVE E",
            "city": "WIGGINS",
            "state": "MS",
            "postal_code": "395772752",
            "telephone_number": "601-928-4446",
            "fax_number": "601-928-4844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON'S PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2019-02-05",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "SIMON",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "601-928-4446",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "00469/01.1",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00035157",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02028875",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Wiggins, MS
• Providers in Wiggins, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.