Provider Demographics
NPI:1407014681
Name:WILSON, STEVEN D (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:D
Last Name:WILSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 US HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-2410
Mailing Address - Country:US
Mailing Address - Phone:270-365-9122
Mailing Address - Fax:270-365-0241
Practice Address - Street 1:500 US HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-2410
Practice Address - Country:US
Practice Address - Phone:270-365-9122
Practice Address - Fax:270-365-0241
Is Sole Proprietor?:No
Enumeration Date:2008-05-24
Last Update Date:2008-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist