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Individual

JONATHAN MARK WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHARMD

Contact information

Practice address
120 PROMINENCE POINT PKWY, CANTON, GA 30114-9008
(770) 720-4825
Mailing address
500 SYCAMORE LN, APT 207, WOODSTOCK, GA 30188-7319
(770) 548-8986

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH026795
GA

Other

Enumeration date
01/10/2013
Last updated
01/10/2013
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