Provider Demographics
NPI:1386748341
Name:WILSON DRUGS INC
Entity type:Organization
Organization Name:WILSON DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-442-9727
Mailing Address - Street 1:4249 HIGHWAY 411
Mailing Address - Street 2:UNIT 5
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-1544
Mailing Address - Country:US
Mailing Address - Phone:423-442-9727
Mailing Address - Fax:423-442-5057
Practice Address - Street 1:4249 HIGHWAY 411
Practice Address - Street 2:UNIT 5
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-1544
Practice Address - Country:US
Practice Address - Phone:423-442-9727
Practice Address - Fax:423-442-5057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TN00000010953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2095776OtherPK
TN3514894Medicaid
TN3514894Medicaid