MEDICARE: MS. BRENDA C WHICKER 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	26014426A	IN

General Provider Information

NPI Number	:	1992091078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRENDA C WHICKER RPH

Provider Business Mailing Address
First Line	:	123 W COUNTY ROAD 750 S
Second Line	:
City	:	CLAYTON
State	:	IN
Zip	:	46118-9515
Country	:	US
Telephone Number	:	317-796-5364
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 W COUNTY ROAD 750 S
Second Line	:
City	:	CLAYTON
State	:	IN
Zip	:	46118-9515
Country	:	US
Telephone Number	:	317-796-5364
Fax Number	:

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

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	06/27/2011

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