Individual
LISA WICKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 430-4555
Mailing address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11469-40
WI
Other
Enumeration date
11/08/2012
Last updated
11/08/2012
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