Wickham Discount Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH26906 Issued in FL

Legal business name

WICKHAM DISCOUNT PHARMACY LLC

Practice address

1060 N Wickham Rd
Melbourne, FL 32935-8937

Phone

(321) 241-6433

Fax

(321) 241-6434

NPI assigned

Sep 18, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ankit Shah, RPH

Title

Owner, Phcy MGR, Pic

Phone

(321) 241-6433

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• WICKHAM PHARMACY Doing business as

Locations

Networks

• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Zina Al Sekooty

  • Pharmacist
  • Melbourne, FL
  • NPI 1982153474
  NPD (past)
• Victoria Alece Revills, PHARMD

  • Pharmacist
  • Melbourne, FL
  • NPI 1508567686
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416355200000",
    "number": "1265868665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 N WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329358937",
            "telephone_number": "321-241-6433",
            "fax_number": "321-241-6434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 N WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329358937",
            "telephone_number": "321-241-6433",
            "fax_number": "321-241-6434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKHAM DISCOUNT PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-18",
        "last_updated": "2014-11-19",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "ANKIT",
        "authorized_official_title_or_position": "OWNER, PHCY MGR, PIC",
        "authorized_official_telephone_number": "321-241-6433",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH26906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010488000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2142537",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WICKHAM PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karin Whitt
• Arrie Olivia Whitten
• Anna Elizabeth Whittington, PA-C
• Kristi Whitton
• Jessica Mortin Wicker
• Wickham Pediatrics Center PS
• Kristen Jane Wiederhold
• Alexandrea Hope Wiegand, M.S., BCBA
• Gabrielle Wienckoski, APRN
• Adam Howard Wiener, D.O.

• Community/Retail Pharmacy in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.