Individual
CLINTON BRAD WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
650 HIAWATHA FARMS RD, MONTICELLO, FL 32344-0821
(850) 728-2562
Mailing address
650 HIAWATHA FARMS RD, MONTICELLO, FL 32344-0821
(850) 728-2562
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS37926
FL
Other
Enumeration date
10/30/2020
Last updated
10/30/2020
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