Provider Demographics
NPI:1558758235
Name:WILSON, KAY
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 APPLEWOOD CENTER PL
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0917
Mailing Address - Country:US
Mailing Address - Phone:864-882-9506
Mailing Address - Fax:864-888-8298
Practice Address - Street 1:201 APPLEWOOD CENTER PL
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0917
Practice Address - Country:US
Practice Address - Phone:864-882-9506
Practice Address - Fax:864-888-8298
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC10824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist