Active NPI
Clayton Wilson
- Pharmacist
- Bishop, CA
National Provider Identifier
1770185860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 49761
- Practice address
- 644 W Line St
Bishop, CA 93514-3315 - Phone
- (760) 872-2522
- NPI assigned
- Nov 12, 2020
- 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 | 49761 | CA | Primary |
Addresses
Primary practice location
644 W Line St
Bishop, CA 93514-3315
Mailing address
644 W Line St
Bishop, CA 93514-3315
Phone (760) 872-2522
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 |
|---|---|---|---|
| 49761 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sabrina Enterprises, Inc. | Current | Accepting new patients |
Locations
644 W Line St
Bishop, CA 93514
Phone (760) 872-2522
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605139200000",
"number": "1770185860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "644 W LINE ST",
"city": "BISHOP",
"state": "CA",
"postal_code": "935143315",
"telephone_number": "760-872-2522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "644 W LINE ST",
"city": "BISHOP",
"state": "CA",
"postal_code": "935143315",
"telephone_number": "760-872-2522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CLAYTON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-12",
"last_updated": "2020-11-12",
"certification_date": "2020-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "49761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bishop, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.