NPIMap

Organization Active NPI

Wilson Pharmacy Group, LLC

Doing business as Wilson Family Pharmacy

  • Community/Retail Pharmacy
  • Matador, TX
National Provider Identifier
1801472626
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
WILSON PHARMACY GROUP, LLC
Doing business as
Wilson Family Pharmacy
Practice address
1224 Main Street
Matador, TX 79244
Phone
(806) 652-3353
Fax
(806) 652-2118
NPI assigned
Mar 22, 2021
Last updated
Aug 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Authorized official

Name
Dr. Brance Wilson, PHARM DNPI 1225337629
Title
Managing Member
Phone
(806) 652-3353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

1224 Main Street
Matador, TX 79244

Mailing address

PO Box 685
Lockney, TX 79241-0685
Phone (806) 652-3353

Other identifiers 1

IdentifierTypeStateIssuer
150426MedicaidTX

Other names 1

  • Wilson Family Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wilson Pharmacy Group LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1616371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724716800000",
    "number": "1801472626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 685",
            "city": "LOCKNEY",
            "state": "TX",
            "postal_code": "792410685",
            "telephone_number": "806-652-3353",
            "fax_number": "806-652-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 MAIN STREET",
            "city": "MATADOR",
            "state": "TX",
            "postal_code": "79244",
            "telephone_number": "806-652-3353",
            "fax_number": "806-652-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON PHARMACY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-22",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "BRANCE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "806-652-3353",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150426",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilson Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wilson Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Matador, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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.