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NPI Code Detail

MEDICARE: MR. DENNIS BRIAN WILSON RPH

MEDICARE: MR. DENNIS BRIAN WILSON 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
1183500000XPharmacist10011TN
2183500000XPharmacist12367NE
3183500000XPharmacist13200KY
4183500000XPharmacistPS39905FL
5183500000XPharmacist17598LA
6183500000XPharmacist13393AZ
7183500000XPharmacist5302034259MI
8183500000XPharmacistPD09341AR
9183500000XPharmacistE-8250MS

General Provider Information

NPI Number : 1649399296
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DENNIS BRIAN WILSON RPH
Provider Business Mailing Address
First Line : 3106 STEEPLEGATE DR
Second Line :
City : GERMANTOWN
State : TN
Zip : 38138-7717
Country : US
Telephone Number : 901-248-3701
Fax Number :
Provider Business Practice Location Address
First Line : 2525 HORIZON LAKE DR
Second Line : SUITE 101
City : MEMPHIS
State : TN
Zip : 38133-8119
Country : US
Telephone Number : 901-248-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 07/08/2007

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