Provider Demographics
NPI:1851440804
Name:WENTZEL, DENNIS (RPH)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:WENTZEL
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 1:349 IMPERIAL LN
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2818
Mailing Address - Country:US
Mailing Address - Phone:314-493-7123
Mailing Address - Fax:
Practice Address - Street 1:13600 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:EARTH CITY
Practice Address - State:MO
Practice Address - Zip Code:63045-1220
Practice Address - Country:US
Practice Address - Phone:314-493-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist