Provider Demographics
NPI:1326418575
Name:WILKES, JERRY JR (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:WILKES
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 US HIGHWAY 401 S
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5089
Mailing Address - Country:US
Mailing Address - Phone:910-277-7771
Mailing Address - Fax:910-277-7618
Practice Address - Street 1:901 US HIGHWAY 401 S
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5089
Practice Address - Country:US
Practice Address - Phone:910-277-7771
Practice Address - Fax:910-277-7618
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist