Provider Demographics
NPI:1679676902
Name:WILKES, LONNA ELAINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LONNA
Middle Name:ELAINE
Last Name:WILKES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 COPPER FIELD CIR
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-6014
Mailing Address - Country:US
Mailing Address - Phone:904-376-5123
Mailing Address - Fax:904-259-5275
Practice Address - Street 1:1436 STATE ROAD 121 S.
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063
Practice Address - Country:US
Practice Address - Phone:904-259-5824
Practice Address - Fax:904-259-5275
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist