Healthcare Provider Details

I. General information

NPI: 1720195845
Provider Name (Legal Business Name): WILKINSON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E HWY 54
EL DORADO SPRINGS MO
64744
US

IV. Provider business mailing address

125 S WASHINGTON STE 100
NEVADA MO
64772
US

V. Phone/Fax

Practice location:
  • Phone: 417-876-3511
  • Fax: 417-876-5827
Mailing address:
  • Phone: 417-667-7599
  • Fax: 417-667-7599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5933
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5933
License Number StateMO

VIII. Authorized Official

Name: MR. MICHAEL W BURNS
Title or Position: PRESIDENT/CEO
Credential: RPH
Phone: 785-448-3600