Provider Demographics
NPI:1588269575
Name:WILKINSON, MARK ALLEN
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-4414
Mailing Address - Country:US
Mailing Address - Phone:276-628-8119
Mailing Address - Fax:276-628-2047
Practice Address - Street 1:801 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-4414
Practice Address - Country:US
Practice Address - Phone:276-628-8119
Practice Address - Fax:276-628-2047
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA020212680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist