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General NPI Number Information
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NPI Number | 1578836458
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Entity Type | Individual
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Provider Name | CHRISTOPHER WILSON PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 1378 EXPERIMENT ST
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City | GRIFFIN
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State | GA
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Zip | 30223-1735
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Country | US
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Telephone | 770-227-5770
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Fax |
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Provider Business Mailing Address
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Address Line | 730 N CHURCH ST
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City | THOMASTON
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State | GA
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Zip | 30286-3618
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Country | US
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Telephone | 706-648-4048
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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 | RPH020575
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License Number State | GA
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