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General NPI Number Information
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NPI Number | 1104791615
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Entity Type | Individual
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Provider Name | BILL JOHN WILSON III PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 9333 IMPERIAL HWY FL 1
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City | DOWNEY
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State | CA
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Zip | 90242-2812
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Country | US
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Telephone | 866-206-2983
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Fax |
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Provider Business Mailing Address
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Address Line | 650 TAMARACK AVE APT 4506
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City | BREA
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State | CA
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Zip | 92821-3219
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Country | US
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Telephone | 559-904-3010
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 91593
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License Number State | CA
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