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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