Individual
MR. KENNETH WAYNE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
134 LA RUE MEDECINE ST, MARKSVILLE, LA 71351-2637
(318) 253-8747
Mailing address
PO BOX 99, MARKSVILLE, LA 71351-0099
(318) 253-8747
Taxonomy
Speciality
Code
Description
License number
State
1835P2201X
Ambulatory Care Pharmacist
Primary
13681
LA
Other
Enumeration date
08/23/2022
Last updated
08/23/2022
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