MS. Reva A Wilson

NPI #1205118981 in Tyler, Texas

Provider Information

NPI Number: 1205118981
Entity Type: Individual
Name: MS. Reva A Wilson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Pharmacist
Enumeration Date: Sep 19, 2011
Last Updated: Sep 19, 2011

Practice Location

Address: 1620 S BROADWAY AVE
City: Tyler
State: Texas
ZIP Code: 75701-4260
Phone: (903) 533-0667

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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