Healthcare Provider Details

I. General information

NPI: 1942540026
Provider Name (Legal Business Name): WILKARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W MAIN ST
MALDEN MO
63863-2114
US

IV. Provider business mailing address

214 W MAIN ST
MALDEN MO
63863-2114
US

V. Phone/Fax

Practice location:
  • Phone: 573-276-3784
  • Fax:
Mailing address:
  • Phone: 573-276-3784
  • Fax: 573-276-2134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2016027108
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE LINDSEY
Title or Position: PHARMACY MANAGER
Credential:
Phone: 573-996-1347