Individual
JENNA WICKERSHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2129 S MAIN ST, BELLEFONTAINE, OH 43311-1557
(937) 592-3464
Mailing address
2129 S MAIN ST, BELLEFONTAINE, OH 43311-1557
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
06010927
OH
Other
Enumeration date
05/02/2017
Last updated
05/02/2017
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