Healthcare Provider Details

I. General information

NPI: 1487572020
Provider Name (Legal Business Name): WILSON PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N JEFFERSON ST
WILSON AR
72395-1127
US

IV. Provider business mailing address

PO BOX 128
WILSON AR
72395-0128
US

V. Phone/Fax

Practice location:
  • Phone: 870-655-8415
  • Fax: 870-655-8676
Mailing address:
  • Phone: 870-655-8415
  • Fax: 870-655-8676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HEATHER WAGNER
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 870-561-1500