Active NPI
Michael Paul Wilson, PHARMACIST
- Pharmacist
- Wake Village, TX
National Provider Identifier
1467776377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 37177
- Practice address
- 4520 W 7TH St
Wake Village, TX 75501-6354 - Phone
- (903) 838-7539
- Fax
- (903) 832-9055
- NPI assigned
- Mar 22, 2010
- Sex
- Male
- Sole proprietor
- No
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 | 37177 | TX | Primary |
| Pharmacist | 183500000X | 16146 | LA |
Addresses
Primary practice location
4520 W 7TH St
Wake Village, TX 75501-6354
Mailing address
4520 W 7TH St
Wake Village, TX 75501-6354
Phone (903) 838-7539
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 37177 | Other | TX | STATE OF TEXAS BOARD OF PHARMACY |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37177 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269216000000",
"number": "1467776377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4520 W 7TH ST",
"city": "WAKE VILLAGE",
"state": "TX",
"postal_code": "755016354",
"telephone_number": "903-838-7539",
"fax_number": "903-832-9055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4520 W 7TH ST",
"city": "WAKE VILLAGE",
"state": "TX",
"postal_code": "755016354",
"telephone_number": "903-838-7539",
"fax_number": "903-832-9055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MICHAEL",
"middle_name": "PAUL",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-03-22",
"last_updated": "2010-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "37177",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "16146",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF TEXAS BOARD OF PHARMACY",
"identifier": "37177",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wake Village, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.