Provider Demographics
NPI:1073208674
Name:WILSON, AARON JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:JAMES
Last Name:WILSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4416
Mailing Address - Country:US
Mailing Address - Phone:304-887-2171
Mailing Address - Fax:
Practice Address - Street 1:781 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2341
Practice Address - Country:US
Practice Address - Phone:304-436-3784
Practice Address - Fax:681-201-5428
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0012835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty