Provider Demographics
NPI:1992598643
Name:WICKHAM, WILLOW
Entity type:Individual
Prefix:
First Name:WILLOW
Middle Name:
Last Name:WICKHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 HARBOUR ISLAND LN UNIT 334
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1472
Mailing Address - Country:US
Mailing Address - Phone:813-378-2382
Mailing Address - Fax:
Practice Address - Street 1:3851 HARBOUR ISLAND LN UNIT 334
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-1472
Practice Address - Country:US
Practice Address - Phone:813-378-2382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist