Provider Demographics
NPI:1407384407
Name:WILSON, CECIL DAVID (RPH)
Entity Type:Individual
Prefix:
First Name:CECIL
Middle Name:DAVID
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 1:4035 BEDEVERE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6402
Mailing Address - Country:US
Mailing Address - Phone:850-206-2731
Mailing Address - Fax:
Practice Address - Street 1:8970 PENSACOLA BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-1927
Practice Address - Country:US
Practice Address - Phone:850-484-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS17043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist