MEDICARE: YE JIN WICKESBERG RPH

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
1	183500000X	Pharmacist	26020891A	IN

General Provider Information

NPI Number	:	1497646947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YE JIN WICKESBERG RPH

Provider Business Mailing Address
First Line	:	711 E 71ST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1065
Country	:	US
Telephone Number	:	317-402-4187
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 WESTFIELD RD
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-1434
Country	:	US
Telephone Number	:	317-773-0760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	07/14/2025

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