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
- 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
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MA.002848 | Other | LA | ME NUMBER |
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 LP | Past | Accepting new patients | |
| Kroger Texas L P | 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.
-
- Community/Retail Pharmacy
- Dallas, TX
- NPI 1013080332
-
- Community/Retail Pharmacy
- Fort Worth, TX
- NPI 1407747439
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": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ME NUMBER",
"identifier": "MA.002848",
"state": "LA"
}
],
"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.