MEDICARE: MR. ANDREW STEPHEN WIRICK PHARMD

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	S015399	AZ

General Provider Information

NPI Number	:	1538494745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW STEPHEN WIRICK PHARMD

Provider Business Mailing Address
First Line	:	4505 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7614
Country	:	US
Telephone Number	:	602-952-1491
Fax Number	:	602-952-9310

Provider Business Practice Location Address
First Line	:	4505 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7614
Country	:	US
Telephone Number	:	602-952-1491
Fax Number	:	602-952-9310

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

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	10/05/2009

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