Wilson Pharmacy LLC
Organization Active NPI Community/Retail Pharmacy · Wilson, AR
NPI 1104954585 · NPPES record last updated Dec 7, 2016
Key facts
- NPI
- 1104954585
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- AR20387 (AR)
- Legal business name
- WILSON PHARMACY LLC
- Practice address
- 5 N Jefferson St
Wilson, AR 72395-1127 - Phone
- (870) 655-8415
- Fax
- (870) 655-8676
- NPI assigned
- Feb 28, 2007
- Organization subpart
- No
Authorized official
- Name
- Heather Wagner, RPH
- Title
- Pharmacist/Owner
- Phone
- (870) 655-8415
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 1
Practitioners 1
-
Linda Carol Bridges, PHARMD
National Provider Directory
- Tax ID family
- Wilson Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | AR20387 | AR | Yes |
Addresses
Primary practice location
5 N Jefferson St
Wilson, AR 72395-1127
Mailing address
PO Box 128
Wilson, AR 72395-0128
Phone (870) 655-8415
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 187710407 | Medicaid | AR | |
| 2166426 | Other | PK |
Other names
- Wilson Pharmacy
Other providers in Wilson, AR
- Linda Carol Bridges
- Moving Upward Inc
- Rivercrest School District
- South Miss. County School District
- Turners Healthcare
- Wilson Pharmacy LLC
All providers in Wilson, AR · Community/Retail Pharmacy in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 7, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.