Healthcare Provider Details

I. General information

NPI: 1154242733
Provider Name (Legal Business Name): KEVIN ARTHUR WILSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15761 IONA AVE
HANFORD CA
93230-9231
US

IV. Provider business mailing address

15761 IONA AVE
HANFORD CA
93230-9231
US

V. Phone/Fax

Practice location:
  • Phone: 559-904-8606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: