Provider Demographics
NPI:1467766477
Name:WILKES, ANN W (DPH)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:W
Last Name:WILKES
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 HIGHLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-660-3335
Mailing Address - Fax:731-660-4223
Practice Address - Street 1:3144 HIGHLAND AVE.
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-660-3335
Practice Address - Fax:731-660-4223
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist