Provider Demographics
NPI:1558970475
Name:WILKERSON, BRANDIE LYNN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRANDIE
Middle Name:LYNN
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:BRANDIE
Other - Middle Name:LYNN
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:19306 MONROE ROAD 971
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAY
Mailing Address - State:MO
Mailing Address - Zip Code:65258-2168
Mailing Address - Country:US
Mailing Address - Phone:660-833-5670
Mailing Address - Fax:
Practice Address - Street 1:300 N MORLEY ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2334
Practice Address - Country:US
Practice Address - Phone:660-263-0909
Practice Address - Fax:660-263-2124
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015024599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20150248599OtherMISSOURI BOARD OF PHARMACY