Provider Demographics
NPI:1245807874
Name:WILSON, SETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:
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 1:171 N MAESTRI RD STE 3
Mailing Address - Street 2:
Mailing Address - City:TONTITOWN
Mailing Address - State:AR
Mailing Address - Zip Code:72762-9818
Mailing Address - Country:US
Mailing Address - Phone:479-361-5727
Mailing Address - Fax:479-361-5623
Practice Address - Street 1:171 N MAESTRI RD STE 3
Practice Address - Street 2:
Practice Address - City:TONTITOWN
Practice Address - State:AR
Practice Address - Zip Code:72762-9818
Practice Address - Country:US
Practice Address - Phone:479-361-5727
Practice Address - Fax:479-361-5623
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist