Organization
G. WILSON ENTERPRISE,INC.
Active
Other names
The Medicine Shoppe Pharmacy #1774
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRISELDA WILSON PHARMD (PHARMACIST,OWNER)
(706) 772-7155
Entity
Organization
Contact information
Practice address
2416 WINDSOR SPRING RD, AUGUSTA, GA 30906-4666
(706) 772-7155
(706) 772-7149
Mailing address
2416 WINDSOR SPRING RD, AUGUSTA, GA 30906-4666
(706) 772-7155
(706) 772-7149
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH018959
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00921566A
—
GA
01
—
1407801566
NPI PROVIDER
GA
05
—
7G8531
—
SC
Enumeration date
02/09/2007
Last updated
08/22/2020
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