Provider Demographics
NPI:1457447385
Name:D & D WILCOX
Entity Type:Organization
Organization Name:D & D WILCOX
Other - Org Name:SERVICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:559-935-2134
Mailing Address - Street 1:222 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-1702
Mailing Address - Country:US
Mailing Address - Phone:559-935-2134
Mailing Address - Fax:559-935-8948
Practice Address - Street 1:222 N 5TH ST
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-1702
Practice Address - Country:US
Practice Address - Phone:559-935-2134
Practice Address - Fax:559-935-8948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY45740333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0530635OtherNCPDP
CAPHA457400Medicaid