Provider Demographics
NPI:1508189960
Name:WILCOX, DAVID T (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
Last Name:WILCOX
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 SHADYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:FINDLEY LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:14736-9712
Mailing Address - Country:US
Mailing Address - Phone:716-769-4169
Mailing Address - Fax:716-769-4169
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-1310
Practice Address - Country:US
Practice Address - Phone:716-326-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030027183500000X
PARP028699L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist