Provider Demographics
NPI:1679281505
Name:WILSONS SAV-MOR DRUGS LLC
Entity type:Organization
Organization Name:WILSONS SAV-MOR DRUGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BULLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:901-355-5556
Mailing Address - Street 1:265 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3126
Mailing Address - Country:US
Mailing Address - Phone:423-623-3456
Mailing Address - Fax:423-623-3049
Practice Address - Street 1:265 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3126
Practice Address - Country:US
Practice Address - Phone:423-623-3456
Practice Address - Fax:423-623-3049
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:423-623-3456
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ033343Medicaid