Active NPI
Mallory Webb Wilson, PHARMD
- Pharmacist
- Moulton, AL
National Provider Identifier
1720509094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17071
- Practice address
- 20332 Al Highway 33
Moulton, AL 35650-9204 - Phone
- (256) 974-4900
- NPI assigned
- Jun 27, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17071 | AL | Primary |
Addresses
Primary practice location
20332 Al Highway 33
Moulton, AL 35650-9204
Mailing address
20332 Al Highway 33
Moulton, AL 35650-9204
Phone (256) 974-4900
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | mallory@moultrierx.com |
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 |
|---|---|---|---|
| 17071 | AL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East LP | Past | Accepting new patients | |
| Wal-Mart Stores East, 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 and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Haleyville, AL
- NPI 1184641474
-
- Pharmacy
- Apollo Beach, FL
- NPI 1437027208
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587427200000",
"number": "1720509094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20332 AL HIGHWAY 33",
"city": "MOULTON",
"state": "AL",
"postal_code": "356509204",
"telephone_number": "256-974-4900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20332 AL HIGHWAY 33",
"city": "MOULTON",
"state": "AL",
"postal_code": "356509204",
"telephone_number": "256-974-4900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MALLORY",
"middle_name": "WEBB",
"name_prefix": "Mrs.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-27",
"last_updated": "2020-04-21",
"certification_date": "2020-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AL",
"license": "17071",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "mallory@moultrierx.com",
"affiliation": "N",
"address_1": "20332 Al Highway 33",
"city": "Moulton",
"state": "AL",
"country_code": "US",
"postal_code": "356509204",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Moulton, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.