Provider Demographics
NPI:1275081382
Name:WILSON, JAMIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2475
Mailing Address - Country:US
Mailing Address - Phone:205-222-9860
Mailing Address - Fax:
Practice Address - Street 1:312 PALISADES BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5148
Practice Address - Country:US
Practice Address - Phone:205-870-7170
Practice Address - Fax:205-870-7866
Is Sole Proprietor?:No
Enumeration Date:2016-09-18
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15236183500000X
MS010053183500000X
SC13997183500000X
TX58059183500000X
FLPS42136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist