Provider Demographics
NPI:1538414586
Name:WILKES, DOROTHY M (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:M
Last Name:WILKES
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 BRIDGEPORT PLACE DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-3345
Mailing Address - Country:US
Mailing Address - Phone:513-257-5078
Mailing Address - Fax:
Practice Address - Street 1:3223 BRIDGEPORT PLACE DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-3345
Practice Address - Country:US
Practice Address - Phone:513-257-5078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223269183500000X
MO2014010077183500000X, 1835P1200X, 1835P2201X
OH032232591835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care