Provider Demographics
NPI:1811272024
Name:WOHLSTADTER, JOSEPH RANDALL (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RANDALL
Last Name:WOHLSTADTER
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 1:519 SOUTH TRUMAN BLVD.
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63029
Mailing Address - Country:US
Mailing Address - Phone:636-937-3641
Mailing Address - Fax:636-937-6124
Practice Address - Street 1:519 SOUTH TRUMAN BLVD.
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63029
Practice Address - Country:US
Practice Address - Phone:636-937-3641
Practice Address - Fax:636-937-6124
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO028612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist