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NPI Code Detail

MEDICARE: DERICK ANTHONY WILKERSON PHARMD

MEDICARE: DERICK ANTHONY WILKERSON PHARMD
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
1183500000XPharmacist23016CO

General Provider Information

NPI Number : 1124623756
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERICK ANTHONY WILKERSON PHARMD
Provider Business Mailing Address
First Line : 3810 BLOOMINGTON ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80922-3203
Country : US
Telephone Number : 719-574-7493
Fax Number :
Provider Business Practice Location Address
First Line : 3810 BLOOMINGTON ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80922-3203
Country : US
Telephone Number : 719-574-7493
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2020
Last Update Date : 12/01/2020

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