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NPI Code Detail

MEDICARE: MR. BRUCE ALAN WILKINSON

MEDICARE: MR. BRUCE ALAN WILKINSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS25388FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033491402
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRUCE ALAN WILKINSON
Provider Business Mailing Address
First Line : 1103 US HIGHWAY 331 S
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32435-3383
Country : US
Telephone Number : 850-951-9882
Fax Number :
Provider Business Practice Location Address
First Line : 1103 US HIGHWAY 331 S
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32435-3383
Country : US
Telephone Number : 850-951-9882
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2011
Last Update Date : 09/12/2011

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Directions to “ MR. BRUCE ALAN WILKINSON ” Practice Location

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