Provider Demographics
NPI:1740292325
Name:WILKINSON PHARMACY, INC
Entity type:Organization
Organization Name:WILKINSON PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BEISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-667-7599
Mailing Address - Street 1:125 S WASHINGTON
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3329
Mailing Address - Country:US
Mailing Address - Phone:417-667-7599
Mailing Address - Fax:417-667-7599
Practice Address - Street 1:1227 E 32ND
Practice Address - Street 2:SUITE 5
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2904
Practice Address - Country:US
Practice Address - Phone:417-623-7907
Practice Address - Fax:417-782-1020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILKINSON PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-12
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626287106Medicaid
0196800008Medicare NSC
MO626287106Medicaid