1184680829 NPI number — WILKINSON PHARMACY INC

Table of content: (NPI 1184680829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184680829 NPI number — WILKINSON PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILKINSON PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184680829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 S WASHINGTON
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
NEVADA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64772-3329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-667-7599
Provider Business Mailing Address Fax Number:
417-667-7599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 W 2ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLDEN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64040-1322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-732-5514
Provider Business Practice Location Address Fax Number:
816-850-5415
Provider Enumeration Date:
04/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
OWNER/CEO/PRESIDENT
Authorized Official Telephone Number:
785-448-3600

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 620587600 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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