Provider Demographics
NPI:1073958682
Name:WILSON, NOAH ALEXANDER
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:ALEXANDER
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 BADHAM DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2909
Mailing Address - Country:US
Mailing Address - Phone:205-602-7050
Mailing Address - Fax:
Practice Address - Street 1:104 OXMOOR RD STE 136
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5937
Practice Address - Country:US
Practice Address - Phone:205-894-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist