NPIMap

Organization Active NPI

Wilson Pharmacy LLC

Doing business as Wilson Pharmacy

  • Community/Retail Pharmacy
  • Wilson, AR
National Provider Identifier
1104954585
Registry record updated Dec 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
AR20387 Issued in AR
Legal business name
WILSON PHARMACY LLC
Doing business as
Wilson Pharmacy
Practice address
5 N Jefferson St
Wilson, AR 72395-1127
Phone
(870) 655-8415
Fax
(870) 655-8676
NPI assigned
Feb 28, 2007
Last updated
Dec 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2016

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

Authorized official

Name
Heather Wagner, RPH
Title
Pharmacist/Owner
Phone
(870) 655-8415

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X AR20387 AR Primary

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 names 1

  • Wilson Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wilson Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481068800000",
    "number": "1104954585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 128",
            "city": "WILSON",
            "state": "AR",
            "postal_code": "723950128",
            "telephone_number": "870-655-8415",
            "fax_number": "870-655-8676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 N JEFFERSON ST",
            "city": "WILSON",
            "state": "AR",
            "postal_code": "723951127",
            "telephone_number": "870-655-8415",
            "fax_number": "870-655-8676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2016-12-07",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "870-655-8415",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR20387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilson Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilson, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; 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.