Provider Demographics
NPI:1518249424
Name:WILSON, CHARLES CHRISTIAN III (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CHRISTIAN
Last Name:WILSON
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 IVORY COAST DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2269
Mailing Address - Country:US
Mailing Address - Phone:702-643-4426
Mailing Address - Fax:
Practice Address - Street 1:3240 IVORY COAST DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2269
Practice Address - Country:US
Practice Address - Phone:702-643-4426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist