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General NPI Number Information
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NPI Number | 1356347132
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Entity Type | Individual
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Provider Name | CONTESSA M WILSON PHARMD, MSM
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Gender | Female
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Dates
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Enumeration Date | 06/25/2005
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 701 E ORANGE ST, HOOPESTON, IL 60942
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City | HOOPESTON
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State | IL
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Zip | 60942-5957
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Country | US
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Telephone | 217-283-5531
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Fax |
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Provider Business Mailing Address
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Address Line | 701 E ORANGE ST
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City | HOOPESTON
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State | IL
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Zip | 60942-1801
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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 | 051-038338
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License Number State | IL
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