Individual
FORREST KANE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
350 HIGHWAY 62 E, MOUNTAIN HOME, AR 72653-3629
(870) 424-3814
Mailing address
350 HIGHWAY 62 E, MOUNTAIN HOME, AR 72653-3629
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PD15839
AR
Other
Enumeration date
09/02/2021
Last updated
09/02/2021
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