Michael A Wilczek

Primary specialty

PharmacistTaxonomy code 183500000X

License

041144 Issued in MO

Practice address

1104 S 25TH St
Bethany, MO 64424-2612

Phone

(660) 425-8171

Fax

(660) 425-8161

NPI assigned

Dec 3, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1598360844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 S 25TH ST",
            "city": "BETHANY",
            "state": "MO",
            "postal_code": "644242612",
            "telephone_number": "660-425-8171",
            "fax_number": "660-425-8161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 S 25TH ST",
            "city": "BETHANY",
            "state": "MO",
            "postal_code": "644242612",
            "telephone_number": "660-425-8171",
            "fax_number": "660-425-8161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILCZEK",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-03",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "041144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Vandivert
• Becky Elizabeth Vanness, LCSW
• Kimberly Karen Vantellman
• Truman Mark Vasko, MD
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0834)
• Sarah E Willhite, ATC, LAT
• Dwight Laughton Youngman, DDS

• Pharmacist in Bethany, MO
• Providers in Bethany, MO by specialty
• Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.