Provider Demographics
NPI:1598041964
Name:WILSON, RONALD EDWARD (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:EDWARD
Last Name:WILSON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-6964
Mailing Address - Country:US
Mailing Address - Phone:702-614-8292
Mailing Address - Fax:702-614-8848
Practice Address - Street 1:2451 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-6964
Practice Address - Country:US
Practice Address - Phone:702-614-8292
Practice Address - Fax:702-614-8848
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist