Provider Demographics
NPI:1437466257
Name:WICHER, STEPHEN ANTHONY (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:WICHER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 WYNESTON RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6544
Mailing Address - Country:US
Mailing Address - Phone:252-321-0222
Mailing Address - Fax:252-321-0508
Practice Address - Street 1:1872 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5704
Practice Address - Country:US
Practice Address - Phone:252-321-0222
Practice Address - Fax:252-321-0508
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11060OtherNC PHARMACY LICENSE