NPIMap

Individual provider Active NPI

Amanda C Wilson, RPH

  • Pharmacist
  • Crystal Springs, MS
National Provider Identifier
1962055053
Registry record updated Jul 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
T-08901 Issued in MS
Practice address
113 Bo Bo Dr
Crystal Springs, MS 39059-2741
Phone
(601) 892-4121
NPI assigned
Jul 18, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X T-08901 MS Primary

Addresses

Primary practice location

113 Bo Bo Dr
Crystal Springs, MS 39059-2741

Mailing address

1009 Kern LN
Crystal Springs, MS 39059-8765
Phone (601) 906-7887

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
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
T-08901MSMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
City Drug, LLC PastSince Jul 25, 2019 Accepting new patients
City Drugs of Crystal Springs, Inc. PastSince Jul 25, 2019 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563408000000",
    "number": "1962055053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 KERN LN",
            "city": "CRYSTAL SPRINGS",
            "state": "MS",
            "postal_code": "390598765",
            "telephone_number": "601-906-7887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 BO BO DR",
            "city": "CRYSTAL SPRINGS",
            "state": "MS",
            "postal_code": "390592741",
            "telephone_number": "601-892-4121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "AMANDA",
        "middle_name": "C",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-18",
        "last_updated": "2019-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "T-08901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Springs, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; 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.