Healthcare Provider Details

I. General information

NPI: 1851568372
Provider Name (Legal Business Name): SANDRA Y WYCHE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 CHAMPION DR
CANTON NC
28716-3032
US

IV. Provider business mailing address

PO BOX 1556
WAYNESVILLE NC
28786-1556
US

V. Phone/Fax

Practice location:
  • Phone: 828-235-2795
  • Fax:
Mailing address:
  • Phone: 828-627-2993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16186
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: