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1114158805 NPI number — RODGER PAUL WILSON RPH

NPI Number: 1114158805
Health Care Provider/Practitioner: RODGER PAUL WILSON RPH

Information about “1114158805” NPI (RODGER PAUL WILSON RPH) exists in 1114158805 in HTML format HTML  |  1114158805 in plain Text format TXT  |  1114158805 in PDF (Portable Document Format) PDF  |  1114158805 in an XML format XML  formats.

NPI Number : 1114158805 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114158805",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILSON",
    "FirstName": "RODGER",
    "MiddleName": "PAUL",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "RPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1138 WYNDEMERE CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LONGMONT",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80501-2322",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "303-579-1100",
    "MailingAddressFaxNumber": "303-702-9133",
    "FirstLinePracticeLocationAddress": "1138 WYNDEMERE CIR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LONGMONT",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80501-2322",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "303-579-1100",
    "PracticeLocationAddressFaxNumber": "303-702-9133",
    "EnumerationDate": "07/29/2009",
    "LastUpdateDate": "07/29/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "1996",
        "LicenseNumberStateCode": "WY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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