Healthcare Provider Details

I. General information

NPI: 1548029457
Provider Name (Legal Business Name): WILKARE PHARMACY OF DONIPHAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 N GRAND AVE
DONIPHAN MO
63935-1405
US

IV. Provider business mailing address

513 N GRAND AVE
DONIPHAN MO
63935-1405
US

V. Phone/Fax

Practice location:
  • Phone: 573-996-4127
  • Fax: 573-996-5973
Mailing address:
  • Phone: 573-996-4127
  • Fax: 573-996-5973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILLIP WILKINS JR.
Title or Position: MANAGING MEMBER
Credential: PHARMD
Phone: 870-351-0846