Provider Demographics
NPI:1013506070
Name:WILCOX, DAVE C
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:C
Last Name:WILCOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 SH 61 #502,
Mailing Address - Street 2:
Mailing Address - City:ANAHUAC
Mailing Address - State:TX
Mailing Address - Zip Code:77514
Mailing Address - Country:US
Mailing Address - Phone:409-267-6141
Mailing Address - Fax:
Practice Address - Street 1:1208 MILLER ST #220
Practice Address - Street 2:
Practice Address - City:ANAHUAC
Practice Address - State:TX
Practice Address - Zip Code:77514-0220
Practice Address - Country:US
Practice Address - Phone:409-267-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist