Provider Demographics
NPI:1023389343
Name:WILKES FAMILY PHARMACY
Entity Type:Organization
Organization Name:WILKES FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MANUS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-667-9347
Mailing Address - Street 1:1300 WESTWOOD LN STE A
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-2638
Mailing Address - Country:US
Mailing Address - Phone:336-667-9347
Mailing Address - Fax:336-667-9350
Practice Address - Street 1:1300 WESTWOOD LN STE A
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2638
Practice Address - Country:US
Practice Address - Phone:336-667-9347
Practice Address - Fax:336-667-9350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10652333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0855188Medicaid
NC2801295OtherMEDICARE PTAN