Provider Demographics
NPI:1285973768
Name:WILSON, ANDREW TROY (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:TROY
Last Name:WILSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10823 CROSS SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5107
Mailing Address - Country:US
Mailing Address - Phone:703-620-2444
Mailing Address - Fax:
Practice Address - Street 1:10823 CROSS SCHOOL RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5107
Practice Address - Country:US
Practice Address - Phone:703-620-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202212432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist