Individual
DR. MARK LEO WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
5049 S 13TH ST, LEAVENWORTH, KS 66048-5581
(913) 727-4810
Mailing address
5049 S 13TH ST, LEAVENWORTH, KS 66048-5581
(913) 727-4810
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9433
NE
Other
Enumeration date
10/29/2010
Last updated
10/29/2010
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