Provider Demographics
NPI:1043256704
Name:WILSON, DONALD E (RPH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:WILSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1128
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-1128
Mailing Address - Country:US
Mailing Address - Phone:478-237-3609
Mailing Address - Fax:478-237-3609
Practice Address - Street 1:204 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3648
Practice Address - Country:US
Practice Address - Phone:478-237-6621
Practice Address - Fax:478-237-2217
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist