Provider Demographics
NPI:1699731695
Name:WILSON, HAROLD WINSTON JR (RPH)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:WINSTON
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:117 WOODMONT LN
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2101
Mailing Address - Country:US
Mailing Address - Phone:434-946-7088
Mailing Address - Fax:434-946-2151
Practice Address - Street 1:198 AMBRIAR PLAZA S MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521
Practice Address - Country:US
Practice Address - Phone:434-946-7088
Practice Address - Fax:434-946-2151
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0202006697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist