Provider Demographics
NPI:1568507192
Name:WILSON, WILLIAM RHEA (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RHEA
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 1:1915 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:IL
Mailing Address - Zip Code:62914-1733
Mailing Address - Country:US
Mailing Address - Phone:618-734-0399
Mailing Address - Fax:618-734-0459
Practice Address - Street 1:1915 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:IL
Practice Address - Zip Code:62914-1733
Practice Address - Country:US
Practice Address - Phone:618-734-0399
Practice Address - Fax:618-734-0459
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist