Provider Demographics
NPI:1467705004
Name:WILKES APOTHECARY LLC
Entity Type:Organization
Organization Name:WILKES APOTHECARY LLC
Other - Org Name:FIEVET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-678-2260
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673-0626
Mailing Address - Country:US
Mailing Address - Phone:706-678-2260
Mailing Address - Fax:706-678-4545
Practice Address - Street 1:115 E ROBERT TOOMBS AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673-1737
Practice Address - Country:US
Practice Address - Phone:706-678-2260
Practice Address - Fax:706-678-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X, 3336S0011X, 3336S0011X
GAPHRE0098833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000027827AMedicaid
GA000027827BMedicaid
2137580OtherPK
2137580OtherPK