Provider Demographics
NPI:1245834266
Name:WILSON, JUSTIN CURTIS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:CURTIS
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 1:945A N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4117
Mailing Address - Country:US
Mailing Address - Phone:276-783-6995
Mailing Address - Fax:276-783-1099
Practice Address - Street 1:945A N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4117
Practice Address - Country:US
Practice Address - Phone:276-783-6995
Practice Address - Fax:276-783-1099
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist