Organization
WILSON PHARMACY INC
Active
Other names
Ballad Health Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE EDWIN HILTON (EVP/CFO)
(423) 302-3467
Entity
Organization
Contact information
Practice address
523 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-8210
(423) 926-6154
(423) 926-5571
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
(423) 926-6154
(423) 926-5571
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0000000490
TN
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2095601
PK
—
05
—
3516186
—
TN
Enumeration date
08/10/2006
Last updated
04/18/2024
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