Provider Demographics
NPI:1366819476
Name:WILSON FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:WILSON FAMILY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JIGNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-688-0100
Mailing Address - Street 1:2845 W PARRISH AVE STE E
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-3337
Mailing Address - Country:US
Mailing Address - Phone:270-688-0100
Mailing Address - Fax:270-688-0700
Practice Address - Street 1:2845 W PARRISH AVE STE E
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3337
Practice Address - Country:US
Practice Address - Phone:270-688-0100
Practice Address - Fax:270-688-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMG0903332B00000X, 332BX2000X
KYP07713333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy