Provider Demographics
NPI:1104110477
Name:WIRKES, DARRIN D (RPH)
Entity type:Individual
Prefix:MR
First Name:DARRIN
Middle Name:D
Last Name:WIRKES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 LINEVILLE RD
Mailing Address - Street 2:SHOPKO EXPRESS #502
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-7122
Mailing Address - Country:US
Mailing Address - Phone:920-662-9450
Mailing Address - Fax:920-662-1912
Practice Address - Street 1:2585 LINEVILLE RD
Practice Address - Street 2:SHOPKO EXPRESS #502
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-7122
Practice Address - Country:US
Practice Address - Phone:920-662-9450
Practice Address - Fax:920-662-1912
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11915-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist