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General NPI Number Information
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NPI Number | 1144638123
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Entity Type | Organization
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Legal Business Name | WIL-MAR CORPORATION
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 736 ROUTE 4
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City | SINAJANA
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State | GU
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Zip | 96910-3368
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Country | US
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Telephone | 671-472-4780
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Fax | 671-472-4782
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Provider Business Mailing Address
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Address Line | PO BOX 24313
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City | BARRIGADA
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State | GU
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Zip | 96921-4313
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Country | US
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Telephone | 671-472-4780
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Fax | 671-472-4782
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MARY CHARGUALAF
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Credential |
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Telephone | 671-632-6001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PCY059
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License Number State | GU
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