NPIMap

Organization Active NPI

Wilson Pharmacy Inc

  • Community/Retail Pharmacy
  • Johnson City, TN
National Provider Identifier
1467567404
Registry record updated Nov 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
4307 Issued in TN
Legal business name
WILSON PHARMACY INC
Practice address
2685 Boones Creek Rd
Ste 105
Johnson City, TN 37615-4722
Phone
(423) 282-6337
Fax
(423) 282-5264
NPI assigned
Aug 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2017

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

Authorized official

Name
Lisa Austin
Title
Avp Reimbursement
Phone
(423) 431-1941

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 4307 TN Primary

Addresses

Primary practice location

2685 Boones Creek Rd
Ste 105
Johnson City, TN 37615-4722

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (423) 926-6154

Other identifiers 2

IdentifierTypeStateIssuer
2095039OtherPK
9440037MedicaidTN

Other names 1

  • Mountain States Pharmacy at Boones Creek Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wilson Pharmacy Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2685 Boones Creek Rd
Ste 105
Johnson City, TN 37615
Phone (423) 282-6337

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510876800000",
    "number": "1467567404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 PRINCETON RD STE 1",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012026",
            "telephone_number": "423-926-6154",
            "fax_number": "423-926-7965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2685 BOONES CREEK RD",
            "address_2": "STE 105",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154722",
            "telephone_number": "423-282-6337",
            "fax_number": "423-282-5264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2017-11-17",
        "status": "A",
        "authorized_official_last_name": "AUSTIN",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "AVP REIMBURSEMENT",
        "authorized_official_telephone_number": "423-431-1941"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "4307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2095039",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9440037",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain States Pharmacy at Boones Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2017; 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.