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General NPI Number Information
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NPI Number | 1821221961
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Entity Type | Individual
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Provider Name | BETHANY WILKS PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 1502 BRAYTON AVENUE
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City | DYERSBURG
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State | TN
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Zip | 38024
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Country | US
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Telephone | 731-285-7267
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Fax | 731-287-0438
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Provider Business Mailing Address
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Address Line | 1492 YELLOW TWIG LANE
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City | DYERSBURG
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State | TN
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Zip | 38024
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Country | US
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Telephone | 731-286-4405
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Fax | 731-287-0438
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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 | 9128
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License Number State | TN
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