Provider Demographics
NPI:1063839561
Name:WILHELM, VICKI JEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:JEAN
Last Name:WILHELM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 18TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-1881
Mailing Address - Country:US
Mailing Address - Phone:507-437-7616
Mailing Address - Fax:507-437-8565
Practice Address - Street 1:1209 18TH AVE NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1881
Practice Address - Country:US
Practice Address - Phone:507-437-7616
Practice Address - Fax:507-437-8565
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist