Provider Demographics
NPI:1962551903
Name:WILSON, WILLIAM J (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:WILSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4997 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2185
Mailing Address - Country:US
Mailing Address - Phone:717-657-7786
Mailing Address - Fax:
Practice Address - Street 1:4997 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2185
Practice Address - Country:US
Practice Address - Phone:717-657-7786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028700L1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy