Organization
WICKHAM DISCOUNT PHARMACY LLC
Active
Other names
WICKHAM PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ANKIT SHAH RPH (OWNER, PHCY MGR, PIC)
(321) 241-6433
Entity
Organization
Contact information
Practice address
1060 N WICKHAM RD, MELBOURNE, FL 32935-8937
(321) 241-6433
(321) 241-6434
Mailing address
1060 N WICKHAM RD, MELBOURNE, FL 32935-8937
(321) 241-6433
(321) 241-6434
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH26906
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010488000
—
FL
01
—
2142537
PK
—
Enumeration date
09/18/2013
Last updated
11/19/2014
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