MEDICARE: WILKE'S VILLAGE PHARMACY

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	9832-040	WI

General Provider Information

NPI Number	:	1134272156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILKE'S VILLAGE PHARMACY

Provider Business Mailing Address
First Line	:	9000 W BURLEIGH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-3632
Country	:	US
Telephone Number	:	414-442-4400
Fax Number	:	414-442-1385

Provider Business Practice Location Address
First Line	:	9000 W BURLEIGH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-3632
Country	:	US
Telephone Number	:	414-442-4400
Fax Number	:	414-442-1385

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS CRAIG WILKE
Credential	:
Telephone Number	:	414-442-4400

Provider Enumeration Date	:	01/21/2007
Last Update Date	:	04/20/2008

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