Provider Demographics
NPI:1780997684
Name:WILCOX, ROGER ALLEN (PHARMD)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ALLEN
Last Name:WILCOX
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 1:6 E MONROE ST STE 1304
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-2728
Mailing Address - Country:US
Mailing Address - Phone:612-296-4590
Mailing Address - Fax:
Practice Address - Street 1:6 E MONROE ST STE 1304
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-2728
Practice Address - Country:US
Practice Address - Phone:612-296-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1186991835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist