Individual
MARK WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
5000 W NATIONAL AVE, MILWAUKEE, WI 53295-0002
(414) 384-2000
Mailing address
3365 CARDINAL DR, BROOKFIELD, WI 53005-7706
(262) 781-1818
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13029
WI
Other
Enumeration date
03/23/2007
Last updated
07/08/2007
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