Active NPI
Everette Glenn Wilson II, PHARMD
- Pharmacist
- Dallas, TX
National Provider Identifier
1427422286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 41901
- Practice address
- 752 Wynnewood Village
Dallas, TX 75224 - Phone
- (214) 942-3191
- NPI assigned
- Nov 17, 2015
- Last updated
- Nov 17, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 018162 | LA | |
| Pharmacist | 183500000X | 41901 | TX | Primary |
Addresses
Primary practice location
752 Wynnewood Village
Dallas, TX 75224
Mailing address
752 Wynnewood Village
Dallas, TX 75224
Phone (214) 942-3191
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 |
|---|---|---|---|
| 41901 | TX | MD | General Practice Dentistry |
| 018162 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Texas L P | Past | Accepting new patients | |
| Kroger Texas LP | 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": "1447718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447718400000",
"number": "1427422286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "752 WYNNEWOOD VILLAGE",
"city": "DALLAS",
"state": "TX",
"postal_code": "75224",
"telephone_number": "214-942-3191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "752 WYNNEWOOD VILLAGE",
"city": "DALLAS",
"state": "TX",
"postal_code": "75224",
"telephone_number": "214-942-3191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "EVERETTE",
"middle_name": "GLENN",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-11-17",
"last_updated": "2015-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "018162",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "41901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.