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NPI Code Detail

MEDICARE: JOEL LARRY WILSON

MEDICARE: JOEL LARRY WILSON
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
1183500000XPharmacist11531NC

General Provider Information

NPI Number : 1619833084
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOEL LARRY WILSON
Provider Business Mailing Address
First Line : 7629 BLUFF POINT LN
Second Line :
City : DENVER
State : NC
Zip : 28037-7549
Country : US
Telephone Number : 704-560-0437
Fax Number :
Provider Business Practice Location Address
First Line : 1000 BLYTHE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-5871
Country : US
Telephone Number : 704-560-0437
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2025
Last Update Date : 12/30/2025

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