Individual
DR. JASON SHANE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
43250 SOUTHERN WALK PLZ, ASHBURN, VA 20148-4462
(703) 729-0693
(703) 723-2876
Mailing address
43250 SOUTHERN WALK PLZ, ASHBURN, VA 20148-4462
(703) 729-0693
(703) 723-2876
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202210696
VA
Other
Enumeration date
10/01/2011
Last updated
10/01/2011
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