Provider Demographics
NPI:1205986593
Name:WILMOT, DEAN (RPH)
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:
Last Name:WILMOT
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 1:1033 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-1935
Mailing Address - Country:US
Mailing Address - Phone:815-223-0460
Mailing Address - Fax:815-223-0462
Practice Address - Street 1:1033 8TH ST
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-1935
Practice Address - Country:US
Practice Address - Phone:815-223-0460
Practice Address - Fax:815-223-0462
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist