Provider Demographics
NPI:1306987425
Name:HAROLD WILSON ENTERPRISES INC
Entity type:Organization
Organization Name:HAROLD WILSON ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:434-946-7088
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:198 AMBRIAR PLAZA
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521-0537
Mailing Address - Country:US
Mailing Address - Phone:434-946-7088
Mailing Address - Fax:434-946-2151
Practice Address - Street 1:198 AMBRIAR PLAZA
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521-0537
Practice Address - Country:US
Practice Address - Phone:434-946-7088
Practice Address - Fax:434-946-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010027893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8505047Medicaid