Healthcare Provider Details

I. General information

NPI: 1013824804
Provider Name (Legal Business Name): DERRISHA MARTRICE WILSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 NW STATE ROUTE 7
BLUE SPRINGS MO
64014-1913
US

IV. Provider business mailing address

1701 NW STATE ROUTE 7
BLUE SPRINGS MO
64014-1913
US

V. Phone/Fax

Practice location:
  • Phone: 816-220-3620
  • Fax:
Mailing address:
  • Phone: 816-220-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2026039580
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: