Individual
PENNY LAINE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2252 N 8TH ST, ROGERS, AR 72756-2842
(479) 621-9188
Mailing address
1606 PARK RIDGE WAY, CAVE SPRINGS, AR 72718-8443
(479) 381-5351
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
2018037540
MO
183500000X
Pharmacist
Primary
PD10308
AR
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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