MEDICARE: JEFFREY ALAN WILDERN

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
1	183500000X	Pharmacist	5302021355	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5302021355	OTHER	MI	STATE LICENSE

General Provider Information

NPI Number	:	1053942102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY ALAN WILDERN

Provider Business Mailing Address
First Line	:	PO BOX 74
Second Line	:
City	:	CHARLOTTE
State	:	MI
Zip	:	48813-0074
Country	:	US
Telephone Number	:	517-543-6350
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 S COCHRAN AVE
Second Line	:
City	:	CHARLOTTE
State	:	MI
Zip	:	48813-1518
Country	:	US
Telephone Number	:	517-543-4905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	01/28/2020

Similar Medicare Providers

1194837039 — WOODWARD DETROIT CVS, L.L.C.
Practice Location Address:

301 S COCHRAN AVE
CHARLOTTE, MI
48813-1518

Practice Phone: 517-543-4905
Practice Fax: 517-543-0169

1487173134 — STACY WELDON
Practice Location Address:

301 S COCHRAN AVE
CHARLOTTE, MI
48813-1518

Practice Phone: 517-543-4905
Practice Fax:

1386279701 — WILLIAM HENRY CLAY RPH
Practice Location Address:

301 S COCHRAN AVE
CHARLOTTE, MI
48813-1518

Practice Phone: 517-543-4905
Practice Fax:

1184259061 — CRAIG MICHAEL ROSS
Practice Location Address:

301 S COCHRAN AVE
CHARLOTTE, MI
48813-1518

Practice Phone: 517-543-4905
Practice Fax:

1326067695 — DR. JANE S HARRELL MD
Practice Location Address:

1518 E 3RD ST , SUITE 150
CHARLOTTE, NC
28204-3200

Practice Phone: 704-806-0038
Practice Fax:

1275695280 — MR. KEVIN BERNARD KING KEVIN KING
Practice Location Address:

800 S MINT ST
CHARLOTTE, NC
28202-1518

Practice Phone: 860-416-2529
Practice Fax:

Directions to “ JEFFREY ALAN WILDERN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.