MEDICARE: WILSON COMMUNITY PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	023775	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3300744	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487751319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSON COMMUNITY PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 950
Second Line	:
City	:	WILSON
State	:	NY
Zip	:	14172-0950
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	272 PETTIT ST
Second Line	:
City	:	WILSON
State	:	NY
Zip	:	14172-9696
Country	:	US
Telephone Number	:	716-751-0140
Fax Number	:	716-751-0167

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	LEANNE BROWN
Credential	:	RPH
Telephone Number	:	716-751-0140

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/13/2010

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