Individual
BRIAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 706-4117
Mailing address
1066 S SILVERSTONE WAY APT A430, MERIDIAN, ID 83642-1348
(601) 870-2523
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2171071
ID
Other
Enumeration date
01/02/2026
Last updated
01/02/2026
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