Provider Demographics
NPI:1578150843
Name:WILSON, JOSHUA RAY (INTERN/EXTERN, BS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RAY
Last Name:WILSON
Suffix:
Gender:M
Credentials:INTERN/EXTERN, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 QUINTARD DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1840
Mailing Address - Country:US
Mailing Address - Phone:256-831-6116
Mailing Address - Fax:866-928-5017
Practice Address - Street 1:610 QUINTARD DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1840
Practice Address - Country:US
Practice Address - Phone:256-831-6116
Practice Address - Fax:866-928-5017
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT55300183700000X
ALS13912183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician