Provider Demographics
NPI:1558254748
Name:WILKINSON, MATTHEW PAUL (RPH)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAUL
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 BROOK COURT
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448
Mailing Address - Country:US
Mailing Address - Phone:985-705-2134
Mailing Address - Fax:
Practice Address - Street 1:201 GREENBRIER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7236
Practice Address - Country:US
Practice Address - Phone:985-893-2970
Practice Address - Fax:985-867-1150
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.014638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist