Healthcare Provider Details

I. General information

NPI: 1376355305
Provider Name (Legal Business Name): THOMAS BARRET WILSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DR MARTIN LUTHER KING JR AVE NE
ALBUQUERQUE NM
87102-3619
US

IV. Provider business mailing address

8919 CLOUDY RD NW
ALBUQUERQUE NM
87120-3989
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-5074
  • Fax:
Mailing address:
  • Phone: 918-698-6506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP00009550
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: