Provider Demographics
NPI:1124329362
Name:WILKINSON, SHERRI TRAHAN
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:TRAHAN
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 HIGHWAY 11 N
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-2065
Mailing Address - Country:US
Mailing Address - Phone:601-799-2087
Mailing Address - Fax:601-799-2971
Practice Address - Street 1:2209 HIGHWAY 11 N
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2065
Practice Address - Country:US
Practice Address - Phone:601-799-2087
Practice Address - Fax:601-799-2971
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist