Provider Demographics
NPI:1306441407
Name:WILSON, SCOTT ARNOLD
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ARNOLD
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:PO BOX 496
Mailing Address - Street 2:
Mailing Address - City:RICHEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15358-0496
Mailing Address - Country:US
Mailing Address - Phone:724-632-6555
Mailing Address - Fax:724-632-5436
Practice Address - Street 1:US HIGHWAY 40 EAST
Practice Address - Street 2:
Practice Address - City:RICHEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15358-0496
Practice Address - Country:US
Practice Address - Phone:724-632-6555
Practice Address - Fax:724-632-5436
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034526R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist