Provider Demographics
NPI:1427196195
Name:WILKINS, J PHILIP (DPH)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:PHILIP
Last Name:WILKINS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 CRUCIFER RD
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:TN
Mailing Address - Zip Code:38345-6969
Mailing Address - Country:US
Mailing Address - Phone:731-968-9067
Mailing Address - Fax:
Practice Address - Street 1:18 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-2012
Practice Address - Country:US
Practice Address - Phone:731-847-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3561OtherLICENSE