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General NPI Number Information
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NPI Number | 1700406196
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Entity Type | Individual
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Provider Name | MELISSA WILSON
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Gender | Female
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Dates
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Enumeration Date | 04/25/2020
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Last Update Date | 04/17/2021
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Provider Practice Location Address
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Address Line | 300 CLINIC DR
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-4989
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Country | US
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Telephone | 270-886-9916
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Fax | 270-887-9393
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Provider Business Mailing Address
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Address Line | 375 EVERETT LN
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-9519
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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 | 017148
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License Number State | KY
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