Provider Demographics
NPI:1376742221
Name:WILSON, DASHAWN HOWELL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DASHAWN
Middle Name:HOWELL
Last Name:WILSON
Suffix:
Gender:F
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 1:195 RAMBO RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:TN
Mailing Address - Zip Code:38255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:319 S LINDELL ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-2440
Practice Address - Country:US
Practice Address - Phone:731-587-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist