Doctor Name: | SHANNON WICKLUND |
NPI Number: | 1770613184 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | T-0008894 |
Business Practice Address: | 217 N. Main Str Heppner, OR - 978360427 |
Business Phone Number: | 5416769158 |
Business Fax Number: | 5416765015 |
Mailing Address: | Po Box 296, HEPPNER |
State: | OR |
Postal Code: | 978360296 |
Phone Number: | 5416765259 |
Fax Number: | |
NPI Enumeration Date: | 03/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 183700000X |
License Number: | T-0008894 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Pharmacy Service Providers |
Taxonomy Classification: | Pharmacy Technician |
Taxonomy Specialization: | |
Taxonomy Definition: | A person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professional judgment of a pharmacist. |