Healthcare Provider Details

I. General information

NPI: 1952374514
Provider Name (Legal Business Name): WENDELL EUGENE LOVETT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 RADFORD BLVD BLDG 7200
ALBANY GA
31705-9911
US

IV. Provider business mailing address

214 S CEDAR CREEK RD
CORDELE GA
31015-6408
US

V. Phone/Fax

Practice location:
  • Phone: 229-639-7809
  • Fax:
Mailing address:
  • Phone: 229-273-7948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15768
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: