Provider Demographics
NPI:1063795904
Name:VOGEL, WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:VOGEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 INDUSTRIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672-5392
Mailing Address - Country:US
Mailing Address - Phone:417-336-6901
Mailing Address - Fax:417-336-6907
Practice Address - Street 1:101 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672-5392
Practice Address - Country:US
Practice Address - Phone:417-336-6901
Practice Address - Fax:417-336-6907
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist