Wilson Itliong Datario, PHARM.D.

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

PH0392 Issued in GU

Practice address

498 Chalan Palosyo
Agana Heights, GU 96910-6427

Phone

(800) 214-1306

NPI assigned

Nov 21, 2020

Last updated

Aug 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1605916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1447853361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "498 CHALAN PALOSYO",
            "city": "AGANA HEIGHTS",
            "state": "GU",
            "postal_code": "969106427",
            "telephone_number": "800-214-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "498 CHALAN PALOSYO",
            "city": "AGANA HEIGHTS",
            "state": "GU",
            "postal_code": "969106427",
            "telephone_number": "800-214-1306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DATARIO",
        "first_name": "WILSON",
        "middle_name": "ITLIONG",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-21",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "GU",
            "license": "PH0392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Thomas Cohen, M.D.
• Elizabeth Grace Conlon, MD
• Selena Coumanis Cox
• Shelby Elizabeth Cuddeback, MD
• Adrian Manuel Cuellar, M.D.
• Ane Delly, MSW, LCSW
• James Gus Demitrack Jr., M.D.
• Nelson Desouza, MD
• Taylor Desrosiers, MD, MBA
• Taylor Dickinson, CRNA

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Agana Heights, GU
• Providers in Agana Heights, GU by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Guam

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.