Active NPI
Lear Anthony Wickens, RPH
- Pharmacist
- Clarkston, WA
National Provider Identifier
1477802015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00018158
- Practice address
- 800 6TH St
Clarkston, WA 99403-2013 - Phone
- (509) 758-2565
- Fax
- (509) 758-2151
- NPI assigned
- Aug 29, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH00018158 | WA | Primary |
Addresses
Primary practice location
800 6TH St
Clarkston, WA 99403-2013
Mailing address
800 6TH St
Clarkston, WA 99403-2013
Phone (509) 758-2565
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH00018158 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346198400000",
"number": "1477802015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 6TH ST",
"city": "CLARKSTON",
"state": "WA",
"postal_code": "994032013",
"telephone_number": "509-758-2565",
"fax_number": "509-758-2151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 6TH ST",
"city": "CLARKSTON",
"state": "WA",
"postal_code": "994032013",
"telephone_number": "509-758-2565",
"fax_number": "509-758-2151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKENS",
"first_name": "LEAR",
"middle_name": "ANTHONY",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-29",
"last_updated": "2012-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00018158",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.