Active NPI
Trent Wilson
- Pharmacist
- Fairmont, WV
National Provider Identifier
1891395240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP0009253
- Practice address
- 100 Crosswind Dr RM P
Fairmont, WV 26554-9162 - Phone
- (681) 214-6390
- Fax
- (304) 906-2444
- NPI assigned
- Oct 27, 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 | RP0009253 | WV | Primary |
Addresses
Primary practice location
100 Crosswind Dr RM P
Fairmont, WV 26554-9162
Mailing address
79 Grace LN
Morgantown, WV 26508-2606
Other practice location 1
1 Walmart Ln
Grafton, WV 26354-9537
Phone (304) 265-6329
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 |
|---|---|---|---|
| RP0009253 | WV | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genoa Healthcare LLC | Current | Accepting new patients | |
| Wal-Mart Stores East, LP | Past | Accepting new patients | |
| Genoa Healthcare LLC | Past | Accepting new patients | |
| Wal-Mart Stores East LP | Past | Accepting new patients |
Locations
100 Crosswind Dr
Rm P
Pleasant Valley, WV 26554
Phone (681) 214-6390
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Long Term Care Pharmacy
- Pleasant Valley, WV
- NPI 1669186763
-
dba Wal-Mart Pharmacy 10-2833
- Community/Retail Pharmacy
- Grafton, WV
- NPI 1467479501
-
- Long Term Care Pharmacy
- Brockton, MA
- NPI 1992521512
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695600000000",
"number": "1891395240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "79 GRACE LN",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "265082606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 CROSSWIND DR RM P",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "265549162",
"telephone_number": "681-214-6390",
"fax_number": "304-906-2444"
}
],
"practiceLocations": [
{
"address_1": "1 Walmart Ln",
"address_purpose": "LOCATION",
"city": "Grafton",
"state": "WV",
"postal_code": "263549537",
"country_code": "US",
"telephone_number": "304-265-6329",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "TRENT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-10-27",
"last_updated": "2023-09-25",
"certification_date": "2023-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WV",
"license": "RP0009253",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairmont, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.