Provider Demographics
NPI:1386080844
Name:WILKERSON, EFFIE JUANITA (RPH)
Entity type:Individual
Prefix:MRS
First Name:EFFIE
Middle Name:JUANITA
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 1:202 WOOD CIRCLE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-2058
Mailing Address - Country:US
Mailing Address - Phone:832-594-1180
Mailing Address - Fax:
Practice Address - Street 1:927 EAST SHAW RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506
Practice Address - Country:US
Practice Address - Phone:713-982-5168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist