Individual provider Active NPI

Matthew Wilson, PHARM.D.

  • Critical Care Pharmacist
  • Kissimmee, FL
National Provider Identifier
1801163993
Registry record updated May 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care PharmacistTaxonomy code 1835C0205X
License
PS52526 Issued in FL
Practice address
700 W Oak St
Kissimmee, FL 34741
Phone
(407) 518-4256
NPI assigned
Nov 17, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5302039491 MI
Critical Care Pharmacist 1835C0205X PS52526 FL Primary

Addresses

Primary practice location

700 W Oak St
Kissimmee, FL 34741

Mailing address

700 W Oak St
Kissimmee, FL 34741-4924
Phone (407) 518-4256

Other practice location 1

44201 Dequindre Rd
Troy, MI 48085-1117
Phone (810) 962-6880

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

LicenseStateTypeSpecialty
5302039491MIMDPharmacist
PS52526FLMDCritical Care Pharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526947200000",
    "number": "1801163993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W OAK ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414924",
            "telephone_number": "407-518-4256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W OAK ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34741",
            "telephone_number": "407-518-4256"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44201 Dequindre Rd",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "MI",
            "postal_code": "480851117",
            "country_code": "US",
            "telephone_number": "810-962-6880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-17",
        "last_updated": "2018-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302039491",
            "primary": false
        },
        {
            "code": "1835C0205X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Critical Care",
            "state": "FL",
            "license": "PS52526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.