Individual
CHARLES WICKERSHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD.
Contact information
Practice address
2020 COFFEE RD, SUITE C2, MODESTO, CA 95355-2427
(209) 522-3367
(209) 522-3375
Mailing address
2020 COFFEE RD, SUITE C2, MODESTO, CA 95355-2427
(209) 522-3367
(209) 522-3375
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
49925
CA
Other
Enumeration date
05/25/2012
Last updated
05/25/2012
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