Provider Demographics
NPI:1174519631
Name:WILSON, JAMES BISHOP (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BISHOP
Last Name:WILSON
Suffix:
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 1:280 SPRING VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-8885
Mailing Address - Country:US
Mailing Address - Phone:270-534-9608
Mailing Address - Fax:270-247-4285
Practice Address - Street 1:414 S 9TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2610
Practice Address - Country:US
Practice Address - Phone:270-247-3232
Practice Address - Fax:270-247-4285
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist