Healthcare Provider Details

I. General information

NPI: 1891014791
Provider Name (Legal Business Name): LAURA WICKS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 E MAYO BLVD
PHOENIX AZ
85054-4502
US

IV. Provider business mailing address

23027 N 43RD PL
PHOENIX AZ
85050-8790
US

V. Phone/Fax

Practice location:
  • Phone: 480-342-1500
  • Fax:
Mailing address:
  • Phone: 602-799-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS016664
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: