Provider Demographics
NPI:1649399296
Name:WILSON, DENNIS BRIAN (RPH)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:BRIAN
Last Name:WILSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 STEEPLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7717
Mailing Address - Country:US
Mailing Address - Phone:901-248-3701
Mailing Address - Fax:
Practice Address - Street 1:2525 HORIZON LAKE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8119
Practice Address - Country:US
Practice Address - Phone:901-248-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10011183500000X
NE12367183500000X
KY13200183500000X
FLPS39905183500000X
LA17598183500000X
AZ13393183500000X
MI5302034259183500000X
ARPD09341183500000X
MSE-8250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist