Provider Demographics
NPI:1063292993
Name:AUFDENBERG, WANDA (RPH)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:AUFDENBERG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 COUNTY ROAD 325
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-9373
Mailing Address - Country:US
Mailing Address - Phone:573-579-3399
Mailing Address - Fax:
Practice Address - Street 1:1723 BROADWAY ST STE 110
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4556
Practice Address - Country:US
Practice Address - Phone:573-331-7900
Practice Address - Fax:573-331-7909
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist