Individual
SHANNON WICKLUND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
217 N. MAIN STR, HEPPNER, OR 97836-0427
(541) 676-9158
(541) 676-5015
Mailing address
PO BOX 296, HEPPNER, OR 97836-0296
(541) 676-5259
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
T-0008894
OR
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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