Provider Demographics
NPI:1962131938
Name:WILKINS, PHILLIP K JR (PHARMD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:K
Last Name:WILKINS
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MO
Mailing Address - Zip Code:63863-2114
Mailing Address - Country:US
Mailing Address - Phone:573-276-3784
Mailing Address - Fax:573-276-2144
Practice Address - Street 1:214 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863-2114
Practice Address - Country:US
Practice Address - Phone:573-276-3784
Practice Address - Fax:573-276-2144
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014021642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist