Provider Demographics
NPI:1457529026
Name:FOWLKES WILKINS, ERICKA (RPH)
Entity type:Individual
Prefix:MS
First Name:ERICKA
Middle Name:
Last Name:FOWLKES WILKINS
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 1:1835 WISTERIA CIR
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-3056
Mailing Address - Country:US
Mailing Address - Phone:917-238-0984
Mailing Address - Fax:917-238-0984
Practice Address - Street 1:1150 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2073
Practice Address - Country:US
Practice Address - Phone:631-208-9354
Practice Address - Fax:631-208-9354
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050593-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist