Individual
KENNETH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6001
Mailing address
3001 CALLA LILLY, FARMINGTON, NM 87401-6714
(801) 879-9920
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5881924-1707
UT
Other
Enumeration date
05/14/2020
Last updated
05/14/2020
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