Individual
DR. MACKENZIE PAULETTE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
JCT HWY 160 & NR 35, HCR 61, TEEC NOS POS, AZ 86514-0000
(928) 656-5000
(928) 656-5272
Mailing address
HCR 61 BOX 30, JCT HWY 160 & NR 35, TEEC NOS POS, AZ 86514-0000
(928) 656-5000
(928) 656-5272
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13429
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
109MPW
NNMC
—
Enumeration date
11/09/2005
Last updated
04/19/2012
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