Provider Demographics
NPI:1073898672
Name:WILKINS, GAYLNE DELANE (RPH)
Entity Type:Individual
Prefix:
First Name:GAYLNE
Middle Name:DELANE
Last Name:WILKINS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:LA
Mailing Address - Zip Code:71418-0428
Mailing Address - Country:US
Mailing Address - Phone:318-649-5406
Mailing Address - Fax:
Practice Address - Street 1:8155 HIGHWAY 165
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:LA
Practice Address - Zip Code:71418-4341
Practice Address - Country:US
Practice Address - Phone:318-649-2641
Practice Address - Fax:318-649-2653
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA116331835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist