Provider Demographics
NPI:1962595215
Name:PARISH, WENDEL IVEY (PHARMOCIST)
Entity type:Individual
Prefix:MR
First Name:WENDEL
Middle Name:IVEY
Last Name:PARISH
Suffix:
Gender:M
Credentials:PHARMOCIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3653 LAKE TELFER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1714
Mailing Address - Country:US
Mailing Address - Phone:407-678-8416
Mailing Address - Fax:
Practice Address - Street 1:12500 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7100
Practice Address - Country:US
Practice Address - Phone:407-384-7116
Practice Address - Fax:407-384-5649
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0012480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist