Provider Demographics
NPI:1073256756
Name:WILKINSON, KENT
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 BAYARD ST REAR DOOR
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-1405
Mailing Address - Country:US
Mailing Address - Phone:814-203-3693
Mailing Address - Fax:
Practice Address - Street 1:419 BAYARD ST REAR DOOR
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-1405
Practice Address - Country:US
Practice Address - Phone:814-203-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy