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General NPI Number Information
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NPI Number | 1376165498
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Entity Type | Organization
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Legal Business Name | WILSON PHARMACY GROUP, LLC
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 701 COMMERCE STREET
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City | SILVERTON
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State | TX
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Zip | 79257
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Country | US
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Telephone | 806-823-2109
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Fax | 806-823-2110
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Provider Business Mailing Address
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Address Line | PO BOX 685
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City | LOCKNEY
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State | TX
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Zip | 79241
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Country | US
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Telephone | 806-652-3353
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Fax | 806-652-2118
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRANCE WILSON
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Credential |
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Telephone | 806-652-3373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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