Provider Demographics
NPI:1093128803
Name:WILKINS, LAUREN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:WILKINS
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 1:4751 ONONDAGA BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3315
Mailing Address - Country:US
Mailing Address - Phone:315-476-2141
Mailing Address - Fax:
Practice Address - Street 1:4751 ONONDAGA BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3315
Practice Address - Country:US
Practice Address - Phone:315-476-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58010183500000X
NYI058010-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist