Provider Demographics
NPI:1083224729
Name:WILKINS, KENDRICK CHARLES
Entity Type:Individual
Prefix:
First Name:KENDRICK
Middle Name:CHARLES
Last Name:WILKINS
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 1:5645 PINEWOOD DR W
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-7576
Mailing Address - Country:US
Mailing Address - Phone:337-263-3890
Mailing Address - Fax:
Practice Address - Street 1:2010 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5206
Practice Address - Country:US
Practice Address - Phone:337-990-4902
Practice Address - Fax:337-990-4904
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist