Provider Demographics
NPI:1255442083
Name:WILSON, DAWN R (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:R
Last Name:WILSON
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10532 Y ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-4533
Mailing Address - Country:US
Mailing Address - Phone:402-659-9937
Mailing Address - Fax:402-401-3585
Practice Address - Street 1:17500 BURKE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2244
Practice Address - Country:US
Practice Address - Phone:402-401-3575
Practice Address - Fax:402-401-3585
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE102131835P1200X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy