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NPI Code Detail

MEDICARE: KAYLAN WILSON PHARMD

MEDICARE: KAYLAN WILSON PHARMD
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
1183500000XPharmacist118879MN
2183500000XPharmacist15002-40WI

General Provider Information

NPI Number : 1215217856
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLAN WILSON PHARMD
Provider Business Mailing Address
First Line : 985 GENEVA AVE N
Second Line :
City : OAKDALE
State : MN
Zip : 55128-7409
Country : US
Telephone Number : 651-731-8480
Fax Number :
Provider Business Practice Location Address
First Line : 985 GENEVA AVE N
Second Line :
City : OAKDALE
State : MN
Zip : 55128-7409
Country : US
Telephone Number : 651-731-8480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2011
Last Update Date : 08/26/2011

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Directions to “ KAYLAN WILSON PHARMD” Practice Location

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