Healthcare Provider Details

I. General information

NPI: 1255065058
Provider Name (Legal Business Name): GARRET N WENDT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 MCKINLEY AVE
KELLOGG ID
83837-2693
US

IV. Provider business mailing address

740 MCKINLEY AVE
KELLOGG ID
83837-2693
US

V. Phone/Fax

Practice location:
  • Phone: 208-786-9303
  • Fax:
Mailing address:
  • Phone: 208-786-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP10121
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: