Provider Demographics
NPI:1316669427
Name:WENZOWSKI, JOSEPH MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:WENZOWSKI
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 1:434 BRYDEN LN
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5802
Mailing Address - Country:US
Mailing Address - Phone:304-670-6302
Mailing Address - Fax:
Practice Address - Street 1:4100 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2356
Practice Address - Country:US
Practice Address - Phone:740-264-8222
Practice Address - Fax:740-264-8233
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0003544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist