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NPI Code Detail

MEDICARE: MOLLY WILSON PHARMD

MEDICARE: MOLLY 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
1183500000XPharmacist33188TN

General Provider Information

NPI Number : 1588212617
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY WILSON PHARMD
Provider Business Mailing Address
First Line : 5811 WOODBURN DR
Second Line :
City : KNOXVILLE
State : TN
Zip : 37919-4155
Country : US
Telephone Number : 865-588-8304
Fax Number :
Provider Business Practice Location Address
First Line : 6005 KINGSTON PIKE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37919-6346
Country : US
Telephone Number : 865-588-5156
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2019
Last Update Date : 09/02/2019

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