Healthcare Provider Details

I. General information

NPI: 1881781763
Provider Name (Legal Business Name): WILCOX DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 MILLER ST
ANAHUAC TX
77514-0220
US

IV. Provider business mailing address

PO BOX 220
ANAHUAC TX
77514-0220
US

V. Phone/Fax

Practice location:
  • Phone: 409-267-6141
  • Fax: 409-267-4292
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5131
License Number StateTX

VIII. Authorized Official

Name: DAVE WILCOX
Title or Position: VP PIC
Credential: RPH
Phone: 409-267-6141