Provider Demographics
NPI:1275868234
Name:WILSON WIL-SAV PHARMACY, INC
Entity Type:Organization
Organization Name:WILSON WIL-SAV PHARMACY, INC
Other - Org Name:WILSON WIL-SAV PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:870-251-2432
Mailing Address - Street 1:5 ALLEN CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-9787
Mailing Address - Country:US
Mailing Address - Phone:870-251-2432
Mailing Address - Fax:870-251-3016
Practice Address - Street 1:5 ALLEN CHAPEL RD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-9787
Practice Address - Country:US
Practice Address - Phone:870-251-2432
Practice Address - Fax:870-251-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
ARAR094863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122262OtherPK
AR179729407Medicaid
AR182449716Medicaid
AR182449716Medicaid