Active NPI
Kenneth Joseph Wilson, PHARM.D.
- Pharmacist
- Cahokia, IL
National Provider Identifier
1376145482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.303473
- Practice address
- 1201 Camp Jackson Rd
Cahokia, IL 62206-2231 - Phone
- (618) 332-2904
- NPI assigned
- Nov 13, 2020
- 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 | 051.303473 | IL | Primary |
Addresses
Primary practice location
1201 Camp Jackson Rd
Cahokia, IL 62206-2231
Mailing address
1009 Main St
Prairie Du Rocher, IL 62277-2258
Phone (618) 772-9796
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.303473 | IL | 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 and National Provider Directory roles.
-
- Pharmacy
- Cahokia, IL
- NPI 1609881861
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606867200000",
"number": "1376145482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1009 MAIN ST",
"city": "PRAIRIE DU ROCHER",
"state": "IL",
"postal_code": "622772258",
"telephone_number": "618-772-9796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 CAMP JACKSON RD",
"city": "CAHOKIA",
"state": "IL",
"postal_code": "622062231",
"telephone_number": "618-332-2904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KENNETH",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-13",
"last_updated": "2020-12-02",
"certification_date": "2020-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.303473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cahokia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.