Provider Demographics
NPI:1922388560
Name:WILCOX, STEPHANIE M (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:WILCOX
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 1:1206 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1889
Mailing Address - Country:US
Mailing Address - Phone:712-527-1200
Mailing Address - Fax:
Practice Address - Street 1:1206 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1889
Practice Address - Country:US
Practice Address - Phone:712-527-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12470183500000X
IA20329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist