Provider Demographics
NPI:1326210741
Name:WONDERLING, RICK L
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:L
Last Name:WONDERLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1151
Mailing Address - Country:US
Mailing Address - Phone:585-593-2611
Mailing Address - Fax:585-593-1903
Practice Address - Street 1:138 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1151
Practice Address - Country:US
Practice Address - Phone:585-593-2611
Practice Address - Fax:585-593-1903
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02812215Medicaid