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General NPI Number Information
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NPI Number | 1346343308
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Entity Type | Individual
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Provider Name | GARY L WILSON PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10000 BAY PINES BLVD #1C120 (119)
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City | BAY PINES
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State | FL
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Zip | 33744
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Country | US
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Telephone | 727-398-6661
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Fax | 727-398-9506
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Provider Business Mailing Address
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Address Line | 2537 WINDING WOOD DR
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City | CLEARWATER
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State | FL
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Zip | 33761-3738
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Country | US
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Telephone | 727-669-5790
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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 | PS 23830
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License Number State | FL
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