Healthcare Provider Details

I. General information

NPI: 1174519631
Provider Name (Legal Business Name): JAMES BISHOP WILSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 S 9TH ST
MAYFIELD KY
42066-2610
US

IV. Provider business mailing address

280 SPRING VALLEY DR
PADUCAH KY
42003-8885
US

V. Phone/Fax

Practice location:
  • Phone: 270-247-3232
  • Fax: 270-247-4285
Mailing address:
  • Phone: 270-534-9608
  • Fax: 270-247-4285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012203
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: