MEDICARE: MR. BERNHARD C WILKINS RPH

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	12240	CO

General Provider Information

NPI Number	:	1942206685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BERNHARD C WILKINS RPH

Provider Business Mailing Address
First Line	:	209 N COLLEGE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2404
Country	:	US
Telephone Number	:	970-482-1234
Fax Number	:	970-482-2412

Provider Business Practice Location Address
First Line	:	209 N COLLEGE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2404
Country	:	US
Telephone Number	:	970-482-1234
Fax Number	:	970-482-2412

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	06/08/2011

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