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General NPI Number Information
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NPI Number | 1497532352
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Entity Type | Individual
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Provider Name | MADDISYN WILKINSON
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Gender | Female
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 1402 PERSHING HWY
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City | SMACKOVER
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State | AR
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Zip | 71762-2300
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Country | US
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Telephone | 870-725-2220
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Fax |
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Provider Business Mailing Address
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Address Line | 625 E 5TH ST
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City | EL DORADO
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State | AR
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Zip | 71730-4003
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Country | US
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Telephone | 318-789-7854
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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 | PNT.048768
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PI23178
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD16706
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License Number State | AR
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