Healthcare Provider Details

I. General information

NPI: 1952417636
Provider Name (Legal Business Name): WILCOX MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date: 04/10/2019
Reactivation Date: 11/02/2019

III. Provider practice location address

217 WOODSTOCK AVE SUITE B
RUTLAND VT
05701-3317
US

IV. Provider business mailing address

4222 PAYSPHERE CIRCLE
CHICAGO IL
60674-0042
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-2808
  • Fax: 855-775-7824
Mailing address:
  • Phone: 800-879-6137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number038-0003391
License Number StateVT
# 6
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SHAPIRO
Title or Position: PRESIDENT & CFO
Credential:
Phone: 800-879-6137