Jesse Wilson, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

15439 Issued in OK

Practice address

3612 SE Lee Blvd
Lawton, OK 73501-8451

Phone

(580) 355-6400

Fax

(580) 355-0451

NPI assigned

Nov 16, 2020

Last updated

Nov 16, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eastside Clinic Pharmacy

  dba Eastside Pharmacy LTC

  • Long Term Care Pharmacy
  • Lawton, OK
  • NPI 1427841360
  NPD Authorized official
• Eastside Clinic Pharmacy

  dba Eastside Pharmacy

  • Community/Retail Pharmacy
  • Lawton, OK
  • NPI 1215958285
  NPD (past)

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

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605484800000",
    "number": "1073116877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3612 SE LEE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735018451",
            "telephone_number": "580-355-6400",
            "fax_number": "580-355-0451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3612 SE LEE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735018451",
            "telephone_number": "580-355-6400",
            "fax_number": "580-355-0451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JESSE",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-16",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OK",
            "license": "15439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Airianna Wilson
• Ashley Nicole Wilson, COTA
• Christina Marie Wilson
• Elizabeth Ann Wilson
• Eric Wilson
• Lasharon Yvette Wilson, LPN
• Erica Michelle Wimberly
• Amy Winfree, M.S., C.M., B.H.R.S.
• Cathy S Wingfield
• John Winningham, DO

• Pharmacist in Lawton, OK
• Providers in Lawton, OK by specialty
• Pharmacist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.