Provider Demographics
NPI:1245439629
Name:WILSON, CHARLES LOUIS (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LOUIS
Last Name:WILSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1034 COUNTY ROAD 4221
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-8173
Mailing Address - Country:US
Mailing Address - Phone:903-575-1817
Mailing Address - Fax:903-572-5912
Practice Address - Street 1:609 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-3646
Practice Address - Country:US
Practice Address - Phone:903-572-4397
Practice Address - Fax:903-572-5912
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist