Provider Demographics
NPI:1588941124
Name:WILSEY, JUSTIN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:WILSEY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11904 TIMBERRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-4764
Mailing Address - Country:US
Mailing Address - Phone:402-312-7230
Mailing Address - Fax:
Practice Address - Street 1:1404 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1945
Practice Address - Country:US
Practice Address - Phone:402-477-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist