Provider Demographics
NPI:1821101585
Name:WILSON, THOMAS WILLIAM (D PH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:WILSON
Suffix:
Gender:M
Credentials:D PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9112 NAWASSA DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-4235
Mailing Address - Country:US
Mailing Address - Phone:405-733-3371
Mailing Address - Fax:
Practice Address - Street 1:7128 E RENO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4478
Practice Address - Country:US
Practice Address - Phone:405-737-3464
Practice Address - Fax:405-737-9554
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist