Healthcare Provider Details

I. General information

NPI: 1144638123
Provider Name (Legal Business Name): WIL-MAR CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 ROUTE 4
SINAJANA GU
96910-3368
US

IV. Provider business mailing address

PO BOX 24313
BARRIGADA GU
96921-4313
US

V. Phone/Fax

Practice location:
  • Phone: 671-472-4780
  • Fax: 671-472-4782
Mailing address:
  • Phone: 671-472-4780
  • Fax: 671-472-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY059
License Number StateGU

VIII. Authorized Official

Name: MARY CHARGUALAF
Title or Position: BUSINESS MANAGER
Credential:
Phone: 671-632-6001