Organization
WILSON PHARMACY INC
Active
Organization
WILSON PHARMACY INC
Active
Other names
Mountain States Pharmacy at Boones Creek
Organization subpart
No
Provider details
NPI number
Authorized official
LISA AUSTIN (AVP REIMBURSEMENT)
(423) 431-1941
Entity
Organization
Contact information
Practice address
2685 BOONES CREEK RD, STE 105, JOHNSON CITY, TN 37615-4722
(423) 282-6337
(423) 282-5264
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
(423) 926-6154
(423) 926-7965
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
4307
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2095039
PK
—
05
—
9440037
—
TN
Enumeration date
08/20/2006
Last updated
11/17/2017
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