Provider Demographics
NPI:1669072021
Name:WILSON, NORVIN BOYD JR (RPH)
Entity type:Individual
Prefix:MR
First Name:NORVIN
Middle Name:BOYD
Last Name:WILSON
Suffix:JR
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 1:6081 W RIO GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-2016
Mailing Address - Country:US
Mailing Address - Phone:352-513-5044
Mailing Address - Fax:
Practice Address - Street 1:2461 E GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3232
Practice Address - Country:US
Practice Address - Phone:352-637-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist