Organization
JO NELL WILKINSON & WILLIAM JACK WILKINSON
Active
Other names
KERMIT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JO NELL WILKINSON RPH (OWNER/PHARMACIST)
(325) 396-4630
Entity
Organization
Contact information
Practice address
810 MYER LN, KERMIT, TX 79745-4634
(432) 586-2556
(432) 586-5934
Mailing address
PO BOX 947, MENARD, TX 76859-0947
(325) 396-4630
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
15496
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
15496
TX
3336C0003X
Community/Retail Pharmacy
25598
TX
3336L0003X
Long Term Care Pharmacy
15496
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00057606
—
NM
05
—
000T4272
—
NM
05
—
0140386-01
—
TX
05
—
0913493-01
—
TX
01
—
143959
TEXAS MEDICAID VENDOR DRUG
TX
Enumeration date
08/02/2006
Last updated
09/29/2008
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