Healthcare Provider Details

I. General information

NPI: 1134406259
Provider Name (Legal Business Name): AIMEE WICKER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD
MERIDIAN ID
83642-6351
US

IV. Provider business mailing address

3933 S BARD AVE
BOISE ID
83716-5592
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-5255
  • Fax:
Mailing address:
  • Phone: 208-908-7983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP5611
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: