Organization
WILSON PHARMACY INC
Active
Other names
Ballad Health Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE EDWIN HILTON (EVP/CFO)
(423) 302-3467
Entity
Organization
Contact information
Practice address
1657 E STONE DR, STE A, KINGSPORT, TN 37660-4669
(423) 247-2126
(423) 247-2138
Mailing address
311 PRINCETON RD, SUITE 1, JOHNSON CITY, TN 37601-2026
(423) 247-2126
(423) 247-2138
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0000003075
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2092005
PK
—
05
—
3516186
—
TN
Enumeration date
08/10/2006
Last updated
04/18/2024
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