Provider Demographics
NPI:1124084868
Name:WILKINSON PHARMACY, INC
Entity type:Organization
Organization Name:WILKINSON PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-448-3600
Mailing Address - Street 1:125 S WASHINGTON
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3329
Mailing Address - Country:US
Mailing Address - Phone:417-667-7599
Mailing Address - Fax:417-667-7599
Practice Address - Street 1:200 E HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:EL DORADO SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64744-1926
Practice Address - Country:US
Practice Address - Phone:417-876-3466
Practice Address - Fax:417-876-5827
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILKINSON PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO623924503Medicaid
MO623924503Medicaid