Active NPI
Earnest Hayne Wilson Jr., PHARMACIST
- Pharmacist
- Titusville, FL
National Provider Identifier
1114299435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS23356
- Practice address
- 2605 Barna Ave
Titusville, FL 32780-5452 - Phone
- (321) 269-7392
- NPI assigned
- Feb 1, 2012
- Last updated
- Feb 1, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS23356 | FL | Primary |
Addresses
Primary practice location
2605 Barna Ave
Titusville, FL 32780-5452
Mailing address
2730 Yorkshire Dr
Titusville, FL 32796-3731
Phone (321) 607-9856
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS23356 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co. | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328054400000",
"number": "1114299435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2730 YORKSHIRE DR",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327963731",
"telephone_number": "321-607-9856",
"fax_number": "321-269-9510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2605 BARNA AVE",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327805452",
"telephone_number": "321-269-7392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "EARNEST",
"middle_name": "HAYNE",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-02-01",
"last_updated": "2012-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS23356",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Titusville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.