MEDICARE: KAILEY MICHELE WILKINS 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
1	183500000X	Pharmacist	42529	SC

General Provider Information

NPI Number	:	1295347391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILEY MICHELE WILKINS PHARMD

Provider Business Mailing Address
First Line	:	1045 LAW LN
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-9558
Country	:	US
Telephone Number	:	843-480-1105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1952 LONG GROVE DR STE 1
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-7579
Country	:	US
Telephone Number	:	843-654-4013
Fax Number	:	843-654-5014

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

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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