Healthcare Provider Details

I. General information

NPI: 1962539536
Provider Name (Legal Business Name): JOHN ROBERT WILSON R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 CARRAWAY BLVD
BIRMINGHAM AL
35234-1998
US

IV. Provider business mailing address

341 WALKER CHAPEL PLZ STE 109
FULTONDALE AL
35068-3404
US

V. Phone/Fax

Practice location:
  • Phone: 205-502-1010
  • Fax:
Mailing address:
  • Phone: 205-502-1010
  • Fax: 866-228-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10123
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: