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NPI Code Detail

MEDICARE: WILSON AARON GRANT RPH

MEDICARE: WILSON AARON GRANT 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
1183500000XPharmacistPH 4362SC
2183500000XPharmacistRPH011309GA

General Provider Information

NPI Number : 1366740565
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILSON AARON GRANT RPH
Provider Business Mailing Address
First Line : 943 PINE LOG RD
Second Line :
City : AIKEN
State : SC
Zip : 29803-7330
Country : US
Telephone Number : 803-648-2366
Fax Number : 803-648-9048
Provider Business Practice Location Address
First Line : 943 PINE LOG RD
Second Line :
City : AIKEN
State : SC
Zip : 29803-7330
Country : US
Telephone Number : 803-648-2366
Fax Number : 803-648-9048
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2011
Last Update Date : 03/11/2011

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Directions to “ WILSON AARON GRANT RPH” Practice Location

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