Kenneth L Wilson

NPI #1972886067 in Loganville, Georgia

Provider Information

NPI Number: 1972886067
Entity Type: Individual
Name: Kenneth L Wilson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Pharmacist
Enumeration Date: Sep 24, 2011
Last Updated: Sep 24, 2011

Practice Location

Address: 4398 ATLANTA HWY
City: Loganville
State: Georgia
ZIP Code: 30052-7314
Phone: (678) 639-0129

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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