Provider Demographics
NPI:1447880414
Name:WILCOX, MICHAEL LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
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:CMR 402 BOX 1556
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-0016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - Street 2:BLDG 3767 PATTERSON ROAD
Practice Address - City:LANDSTUHL
Practice Address - State:RHEINLAND-PFALZ
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:314-590-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.299049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist