Healthcare Provider Details

I. General information

NPI: 1811612823
Provider Name (Legal Business Name): ANDREW WILKS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NW 80TH BLVD
GAINESVILLE FL
32606-9177
US

IV. Provider business mailing address

2008 SW 42ND WAY APT B
GAINESVILLE FL
32607-5422
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-2525
  • Fax: 888-276-7948
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61283
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: