Provider Demographics
NPI:1659671725
Name:WELLIKSON, SARAH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:WELLIKSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:714 S VAL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3140
Mailing Address - Country:US
Mailing Address - Phone:480-654-9337
Mailing Address - Fax:
Practice Address - Street 1:714 S VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3140
Practice Address - Country:US
Practice Address - Phone:480-654-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist