Individual
DOUG WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM D
Contact information
Practice address
2900 HEARTLAND DR, CORALVILLE, IA 52241-2740
(319) 545-3201
Mailing address
981 44TH ST SE, CEDAR RAPIDS, IA 52403-3923
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
14755
WI
183500000X
Pharmacist
Primary
20533
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14755
PHARMACY LICENSE NUMBER
WI
01
—
20533
PHARMACY LICENSE NUMBER
IA
Enumeration date
11/18/2018
Last updated
11/18/2018
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