Individual
DR. WALLACE WICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
1030 JEFFERSON AVE, MEMPHIS, TN 38104-2127
(901) 523-8990
Mailing address
2592 ROSEHAVEN ST, GERMANTOWN, TN 38138-5737
(901) 289-3609
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
028013
MO
Other
Enumeration date
09/02/2006
Last updated
07/08/2007
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