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General NPI Number Information
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NPI Number | 1194019042
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Entity Type | Individual
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Provider Name | ANGELA WILKERSON RPH
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Gender | Female
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 01/20/2019
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Provider Practice Location Address
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Address Line | 40 THF BLVD
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City | CHESTERFIELD
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State | MO
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Zip | 63005-1150
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Country | US
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Telephone | 636-536-6215
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Fax |
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Provider Business Mailing Address
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Address Line | 3750 STATE ROUTE 15
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City | FREEBURG
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State | IL
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Zip | 62243-1908
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Country | US
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Telephone | 618-977-8719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2010033108
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License Number State | MO
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