Provider Demographics
NPI:1093040297
Name:WILCOX, KIRK SHAWGO (PHAM D , BS)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:SHAWGO
Last Name:WILCOX
Suffix:
Gender:M
Credentials:PHAM D , BS
Other - Prefix:
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Mailing Address - Street 1:2727 E BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-1530
Mailing Address - Country:US
Mailing Address - Phone:480-464-4742
Mailing Address - Fax:480-644-0964
Practice Address - Street 1:2727 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-1530
Practice Address - Country:US
Practice Address - Phone:480-464-4742
Practice Address - Fax:480-644-0964
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZS0107361835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist