Provider Demographics
NPI:1144638123
Name:WIL-MAR CORPORATION
Entity type:Organization
Organization Name:WIL-MAR CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARGUALAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-632-6001
Mailing Address - Street 1:PO BOX 24313
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96921-4313
Mailing Address - Country:US
Mailing Address - Phone:671-472-4780
Mailing Address - Fax:671-472-4782
Practice Address - Street 1:736 ROUTE 4
Practice Address - Street 2:
Practice Address - City:SINAJANA
Practice Address - State:GU
Practice Address - Zip Code:96910-3368
Practice Address - Country:US
Practice Address - Phone:671-472-4780
Practice Address - Fax:671-472-4782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GUPCY0593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146926OtherPK