Provider Demographics
NPI:1639490055
Name:WILKINSON PHARMACY INC
Entity Type:Organization
Organization Name:WILKINSON PHARMACY INC
Other - Org Name:WILKINSON PHARMACY 9
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BEISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-667-7599
Mailing Address - Street 1:125 S WASHINGTON ST
Mailing Address - Street 2:SUITE 100
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 1:1227 E 32ND ST STE 5
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2904
Practice Address - Country:US
Practice Address - Phone:417-623-7907
Practice Address - Fax:417-782-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20100187163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1639490055Medicaid
2639106OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0196800008Medicare NSC