Provider Demographics
NPI:1417750274
Name:WILSON, ADAM J (PHARMD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:WILSON
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 DIAMOND HEAD RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-1692
Mailing Address - Country:US
Mailing Address - Phone:785-633-7460
Mailing Address - Fax:
Practice Address - Street 1:429 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1074
Practice Address - Country:US
Practice Address - Phone:785-448-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-101020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist