Provider Demographics
NPI:1598875379
Name:WILSON FAMILY PHARMACIES INC
Entity Type:Organization
Organization Name:WILSON FAMILY PHARMACIES INC
Other - Org Name:GRAHAM DRUG CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-285-8737
Mailing Address - Street 1:116 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466
Mailing Address - Country:US
Mailing Address - Phone:910-285-8737
Mailing Address - Fax:910-285-8550
Practice Address - Street 1:116 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466
Practice Address - Country:US
Practice Address - Phone:910-285-8737
Practice Address - Fax:910-285-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04948333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703114OtherMEDICAID MCD
NC0315218Medicaid
NC0315218Medicaid
NC7703114OtherMEDICAID MCD