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General NPI Number Information
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NPI Number | 1134272156
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Entity Type | Organization
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Legal Business Name | WILKE'S VILLAGE PHARMACY
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Dates
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Enumeration Date | 01/21/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 9000 W BURLEIGH ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-3632
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Country | US
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Telephone | 414-442-4400
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Fax | 414-442-1385
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Provider Business Mailing Address
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Address Line | 9000 W BURLEIGH ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-3632
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Country | US
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Telephone | 414-442-4400
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Fax | 414-442-1385
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS CRAIG WILKE
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Credential |
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Telephone | 414-442-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 9832-040
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License Number State | WI
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