Provider Demographics
NPI:1184946261
Name:WILK, HARRY LIONEL (RPH)
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:LIONEL
Last Name:WILK
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 1:7055 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2804
Mailing Address - Country:US
Mailing Address - Phone:520-546-6535
Mailing Address - Fax:520-546-6859
Practice Address - Street 1:7055 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2804
Practice Address - Country:US
Practice Address - Phone:520-546-6535
Practice Address - Fax:520-546-6859
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist