Provider Demographics
NPI:1568761088
Name:WILSON, ADRIAN SHAWN REID (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:SHAWN REID
Last Name:WILSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CRYSTAL SPRING AVE SW STE 110
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2465
Mailing Address - Country:US
Mailing Address - Phone:540-676-7053
Mailing Address - Fax:540-853-0910
Practice Address - Street 1:2001 CRYSTAL SPRING AVE SW STE 110
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2465
Practice Address - Country:US
Practice Address - Phone:540-676-7053
Practice Address - Fax:540-853-0910
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist