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General NPI Number Information
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NPI Number | 1093260499
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Entity Type | Individual
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Provider Name | STEPHANIE WICK
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Gender | Female
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Dates
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Enumeration Date | 08/16/2016
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 20 MERRICK RD
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City | AMITYVILLE
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State | NY
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Zip | 11701-3455
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Country | US
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Telephone | 631-691-0428
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Fax |
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Provider Business Mailing Address
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Address Line | 224 GRANT ST
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-1520
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Country | US
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Telephone | 516-557-6230
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 62023
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License Number State | NY
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