Individual
SHANNON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D
Contact information
Practice address
3535 LONE OAK RD, PADUCAH, KY 42003-5701
(270) 554-7944
Mailing address
280 SPRING VALLEY DR, PADUCAH, KY 42003-8885
(270) 534-9608
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
012463
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012463
STATE LICENSE
KY
Enumeration date
08/05/2006
Last updated
07/08/2007
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