Provider Demographics
NPI:1417238288
Name:WICHMANN, HEINRICH FRIEDRICH (BPHARM)
Entity Type:Individual
Prefix:MR
First Name:HEINRICH
Middle Name:FRIEDRICH
Last Name:WICHMANN
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 FOREST AVE
Mailing Address - Street 2:APARTMENT 24
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1816
Mailing Address - Country:US
Mailing Address - Phone:207-615-9888
Mailing Address - Fax:
Practice Address - Street 1:120 MAIN STREET
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038
Practice Address - Country:US
Practice Address - Phone:207-839-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist