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NPI Code Detail

MEDICARE: HEIDI LOUISE WICKHAM

MEDICARE: HEIDI LOUISE WICKHAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist16474NV

General Provider Information

NPI Number : 1235415027
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI LOUISE WICKHAM
Provider Business Mailing Address
First Line : 5630 NEOSHO ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-4213
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S BOULDER HWY
Second Line :
City : HENDERSON
State : NV
Zip : 89015-8506
Country : US
Telephone Number : 702-567-5454
Fax Number : 702-567-5409
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2011
Last Update Date : 10/25/2011

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Directions to “ HEIDI LOUISE WICKHAM ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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