Jeffrey Alan Wildern

Primary specialty

PharmacistTaxonomy code 183500000X

License

5302021355 Issued in MI

Practice address

301 S Cochran Ave
Charlotte, MI 48813-1518

Phone

(517) 543-4905

NPI assigned

Jan 28, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Woodward Detroit CVS, L.L.C.

  • Pharmacy
  • Charlotte, MI
  • NPI 1194837039
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1053942102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 74",
            "city": "CHARLOTTE",
            "state": "MI",
            "postal_code": "488130074",
            "telephone_number": "517-543-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S COCHRAN AVE",
            "city": "CHARLOTTE",
            "state": "MI",
            "postal_code": "488131518",
            "telephone_number": "517-543-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDERN",
        "first_name": "JEFFREY",
        "middle_name": "ALAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-28",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302021355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5302021355",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacy Weldon
• Chad Wetzel
• Laura Wieland
• Wildern Durable Supplies LLC
• Harper T Wildern, O.D.
• Wilderns Drug Store
• Jessica Marie Wilkinson, RN
• Karri Wills, PT
• Sally King Wilson, MD
• Holly Gene Wixon

• Pharmacist in Charlotte, MI
• Providers in Charlotte, MI by specialty
• Pharmacist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.