Healthcare Provider Details

I. General information

NPI: 1255442083
Provider Name (Legal Business Name): DAWN R WILSON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17500 BURKE ST
OMAHA NE
68118-2244
US

IV. Provider business mailing address

10532 Y ST
OMAHA NE
68127-4533
US

V. Phone/Fax

Practice location:
  • Phone: 402-401-3575
  • Fax: 402-401-3585
Mailing address:
  • Phone: 402-659-9937
  • Fax: 402-401-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10213
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number10213
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: