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General NPI Number Information
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NPI Number | 1316543846
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Entity Type | Individual
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Provider Name | EMILY SUE WILSON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 12/13/2020
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Provider Practice Location Address
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Address Line | 303 S STATE ST
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City | JERSEYVILLE
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State | IL
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Zip | 62052-1852
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Country | US
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Telephone | 618-498-1144
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 102
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City | PIASA
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State | IL
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Zip | 62079-0102
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Country | US
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Telephone |
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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 | 051.302265
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2019034281
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License Number State | MO
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