Provider Demographics
NPI:1588836415
Name:WILKINSON PHARMACY, INC
Entity Type:Organization
Organization Name:WILKINSON PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-448-3600
Mailing Address - Street 1:125 S WASHINGTON
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3329
Mailing Address - Country:US
Mailing Address - Phone:417-667-7599
Mailing Address - Fax:417-667-7599
Practice Address - Street 1:113 E US HIGHWAY 54 STE 2
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-7320
Practice Address - Country:US
Practice Address - Phone:573-346-3396
Practice Address - Fax:573-346-5257
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILKINSON PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-01
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1588836415Medicaid
MO620659706Medicaid
MO1588836415Medicaid
MO620659706Medicaid