Healthcare Provider Details

I. General information

NPI: 1053449546
Provider Name (Legal Business Name): AARON PAUL WILSON R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 N. TELSHOR BLVD
LAS CRUCES NM
88011
US

IV. Provider business mailing address

5068 GALINA DR
LAS CRUCES NM
88012-0646
US

V. Phone/Fax

Practice location:
  • Phone: 505-521-7890
  • Fax:
Mailing address:
  • Phone: 505-373-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number00004650
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: