Healthcare Provider Details

I. General information

NPI: 1184941031
Provider Name (Legal Business Name): BURKE REID WILSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 7TH ST BLDG 700700-A
ROBINS AFB GA
31098-2227
US

IV. Provider business mailing address

655 7TH ST BLDG 700700-A
ROBINS AFB GA
31098-2227
US

V. Phone/Fax

Practice location:
  • Phone: 478-327-7850
  • Fax:
Mailing address:
  • Phone: 478-327-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14239
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number14239
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: