Provider Demographics
NPI:1194019042
Name:WILKERSON, ANGELA (RPH)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 STATE ROUTE 15
Mailing Address - Street 2:
Mailing Address - City:FREEBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62243-1908
Mailing Address - Country:US
Mailing Address - Phone:618-977-8719
Mailing Address - Fax:
Practice Address - Street 1:40 THF BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1150
Practice Address - Country:US
Practice Address - Phone:636-536-6215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010033108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist