Provider Demographics
NPI:1235517178
Name:WILSON, CHARLES W JR (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:PHARMACIST
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Mailing Address - Street 1:4675 N SHALLOWFORD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6309
Mailing Address - Country:US
Mailing Address - Phone:770-455-1144
Mailing Address - Fax:770-936-8989
Practice Address - Street 1:4675 N SHALLOWFORD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6309
Practice Address - Country:US
Practice Address - Phone:770-455-1144
Practice Address - Fax:770-936-8989
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
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Provider Licenses
StateLicense IDTaxonomies
GARPH013901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist