Healthcare Provider Details

I. General information

NPI: 1720185333
Provider Name (Legal Business Name): WILKINSON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 W ELM
LEBANON MO
65536
US

IV. Provider business mailing address

125 S WASHINGTON STE 100
NEVADA MO
64772
US

V. Phone/Fax

Practice location:
  • Phone: 417-532-4431
  • Fax: 417-533-1291
Mailing address:
  • Phone: 417-667-7599
  • Fax: 417-667-7599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number6374
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6374
License Number StateMO

VIII. Authorized Official

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