Provider Demographics
NPI:1336454289
Name:WILKINSON, KEITH DANIEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:DANIEL
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 WOOD DUCK LN
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-1678
Mailing Address - Country:US
Mailing Address - Phone:985-649-2994
Mailing Address - Fax:504-309-2779
Practice Address - Street 1:3001 PARIS RD
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-3223
Practice Address - Country:US
Practice Address - Phone:985-649-2994
Practice Address - Fax:504-309-2779
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist