Wilson's Pharmacy of Canton, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE007502 Issued in GA

Legal business name

WILSON'S PHARMACY OF CANTON, INC

Doing business as

Medicine Shoppe

Practice address

231 Riverstone Pkwy
Suite 107
Canton, GA 30114-2463

Phone

(770) 720-7450

Fax

(770) 479-4443

NPI assigned

Nov 8, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Tim Wilson, R.PH

Title

Owner

Phone

(770) 720-7450

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Medicine Shoppe Doing business as

Locations

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1396815262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 RIVERSTONE PKWY",
            "address_2": "SUITE 107",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142463",
            "telephone_number": "770-720-7450",
            "fax_number": "770-479-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 RIVERSTONE PKWY",
            "address_2": "SUITE 107",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142463",
            "telephone_number": "770-720-7450",
            "fax_number": "770-479-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON'S PHARMACY OF CANTON, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-720-7450",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE007502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00537105A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "1139105",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicine Shoppe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cheney Fenn Wilson, M.D.
• Drew Wilson, MED., LAPC
• Jessica Wilson
• Jonathan Mark Wilson, PHARMD
• Tiffani Amber Wilson, APRN
• Deborah Windham, R.PH.
• With a Child's Heart, LLC.
• Emily Wolff, PA-C
• John Thomas Womack Jr., OD
• Women's Imaging Specialists - Canton, LLC

• Community/Retail Pharmacy in Canton, GA
• Providers in Canton, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.