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General NPI Number Information
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NPI Number | 1437137320
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Entity Type | Individual
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Provider Name | RICHARD WAIDE WILSON PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5805 MANATEE AVE W
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City | BRADENTON
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State | FL
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Zip | 34209-2542
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Country | US
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Telephone | 941-795-5075
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Fax | 941-794-6946
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Provider Business Mailing Address
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Address Line | 5105 24TH AVENUE DR W
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City | BRADENTON
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State | FL
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Zip | 34209-5617
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Country | US
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Telephone | 941-792-4885
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Fax | 941-792-4885
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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 | PS0009456
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License Number State | FL
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