Healthcare Provider Details

I. General information

NPI: 1023505542
Provider Name (Legal Business Name): BLACKHAWK PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 LAFAYETTE RD
EVANSDALE IA
50707-1025
US

IV. Provider business mailing address

3506 LAFAYETTE RD
EVANSDALE IA
50707-1025
US

V. Phone/Fax

Practice location:
  • Phone: 319-233-3395
  • Fax: 319-233-3099
Mailing address:
  • Phone: 319-233-3395
  • Fax: 319-233-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1644
License Number StateIA

VIII. Authorized Official

Name: DR. WESLEY CHARLES PILKINGTON
Title or Position: OFFICER
Credential: PHARMD
Phone: 319-233-3395