Provider Demographics
NPI:1679895346
Name:WILKINSON, LORI MAJOR (PHARMD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MAJOR
Last Name:WILKINSON
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 1:542 RIVER HWY
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6829
Mailing Address - Country:US
Mailing Address - Phone:704-658-9180
Mailing Address - Fax:704-658-9184
Practice Address - Street 1:542 RIVER HWY
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6829
Practice Address - Country:US
Practice Address - Phone:704-658-9180
Practice Address - Fax:704-658-9184
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0497237Medicaid