Provider Demographics
NPI:1912255894
Name:WILKINS, JODI L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:L
Last Name:WILKINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2120
Mailing Address - Country:US
Mailing Address - Phone:719-587-3076
Mailing Address - Fax:719-587-3077
Practice Address - Street 1:1301 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2120
Practice Address - Country:US
Practice Address - Phone:719-587-3076
Practice Address - Fax:719-587-3077
Is Sole Proprietor?:No
Enumeration Date:2012-08-26
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist