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General NPI Number Information
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NPI Number | 1861917312
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Entity Type | Individual
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Provider Name | CHRISTOPHER ROBERT WILSON JR. PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/06/2017
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 1501 SAN PEDRO DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108
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Country | US
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Telephone | 505-265-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 13150 WENONAH AVE SE APT 327
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-3856
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 0021776
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License Number State | CO
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