Provider Demographics
NPI:1699119313
Name:WICKLIFFE PHARMACEUTICALS, INC.
Entity type:Organization
Organization Name:WICKLIFFE PHARMACEUTICALS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-389-7470
Mailing Address - Street 1:4340 GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-9115
Mailing Address - Country:US
Mailing Address - Phone:859-389-7470
Mailing Address - Fax:859-381-9252
Practice Address - Street 1:4340 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-9115
Practice Address - Country:US
Practice Address - Phone:859-389-7470
Practice Address - Fax:859-381-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy