Provider Demographics
NPI:1720377609
Name:CRICK, WENDY THOMPSON (RPH)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:THOMPSON
Last Name:CRICK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 LEBANON PIKE
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1475
Mailing Address - Country:US
Mailing Address - Phone:615-883-4259
Mailing Address - Fax:615-889-6439
Practice Address - Street 1:4400 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1475
Practice Address - Country:US
Practice Address - Phone:615-883-4259
Practice Address - Fax:615-889-6439
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist