Active NPI
Charles Marion Wilson, RPH
- Pharmacist
- Castle Hayne, NC
National Provider Identifier
1730475484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 06965
- Practice address
- 5712 Castle Hayne Rd
Castle Hayne, NC 28429-5112 - Phone
- (910) 675-2222
- Fax
- (910) 675-2643
- NPI assigned
- Jun 21, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 06965 | NC | Primary |
Addresses
Primary practice location
5712 Castle Hayne Rd
Castle Hayne, NC 28429-5112
Mailing address
5712 Castle Hayne Rd
Castle Hayne, NC 28429-5112
Phone (910) 675-2222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0655597 | Medicaid | NC |
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06965 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308614400000",
"number": "1730475484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5712 CASTLE HAYNE RD",
"city": "CASTLE HAYNE",
"state": "NC",
"postal_code": "284295112",
"telephone_number": "910-675-2222",
"fax_number": "910-675-2643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5712 CASTLE HAYNE RD",
"city": "CASTLE HAYNE",
"state": "NC",
"postal_code": "284295112",
"telephone_number": "910-675-2222",
"fax_number": "910-675-2643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CHARLES",
"middle_name": "MARION",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-21",
"last_updated": "2011-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "06965",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0655597",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Castle Hayne, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.