Provider Demographics
NPI:1821420100
Name:WILKERSON, JERRUND THOMAS (RPH)
Entity Type:Individual
Prefix:
First Name:JERRUND
Middle Name:THOMAS
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 PERIMETER CTR N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-3402
Mailing Address - Country:US
Mailing Address - Phone:770-329-5757
Mailing Address - Fax:770-594-9108
Practice Address - Street 1:303 PERIMETER CTR N
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-3402
Practice Address - Country:US
Practice Address - Phone:770-329-5757
Practice Address - Fax:770-594-9108
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0191481835P1200X
FLPS161821835P1200X
AL95481835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy