Provider Demographics
NPI:1700173051
Name:WILKINS, PHILLIP SR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:WILKINS
Suffix:SR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513B N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935-1405
Mailing Address - Country:US
Mailing Address - Phone:573-996-3784
Mailing Address - Fax:
Practice Address - Street 1:513B N GRAND AVE
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935-1405
Practice Address - Country:US
Practice Address - Phone:573-996-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009035951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist