MEDICARE: WILSON PAGAN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP-040658-L	PA

General Provider Information

NPI Number	:	1124025945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILSON PAGAN RPH

Provider Business Mailing Address
First Line	:	101 E LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1011
Country	:	US
Telephone Number	:	215-425-2800
Fax Number	:	215-425-2889

Provider Business Practice Location Address
First Line	:	101 E LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1011
Country	:	US
Telephone Number	:	215-425-2800
Fax Number	:	215-425-2889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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