Active NPI
Brendon Wilson
- Pharmacist
- Willow Springs, MO
National Provider Identifier
1770195596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2015027180
- Practice address
- 101 E Main St
Willow Springs, MO 65793-1413 - Phone
- (417) 469-3005
- NPI assigned
- Aug 21, 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 | 2015027180 | MO | Primary |
Addresses
Primary practice location
101 E Main St
Willow Springs, MO 65793-1413
Mailing address
PO Box 278
Willow Springs, MO 65793-0278
Phone (417) 293-9546
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 |
|---|---|---|---|
| 2015027180 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597968000000",
"number": "1770195596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 278",
"city": "WILLOW SPRINGS",
"state": "MO",
"postal_code": "657930278",
"telephone_number": "417-293-9546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 E MAIN ST",
"city": "WILLOW SPRINGS",
"state": "MO",
"postal_code": "657931413",
"telephone_number": "417-469-3005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "BRENDON",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-21",
"last_updated": "2020-08-21",
"certification_date": "2020-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2015027180",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willow Springs, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.