Healthcare Provider Details

I. General information

NPI: 1699239137
Provider Name (Legal Business Name): WENDY WEGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PITTSFIELD RD STE B
MT STERLING IL
62353-1843
US

IV. Provider business mailing address

200 PITTSFIELD RD STE B
MT STERLING IL
62353-1843
US

V. Phone/Fax

Practice location:
  • Phone: 217-653-1478
  • Fax: 217-773-2832
Mailing address:
  • Phone: 217-653-1478
  • Fax: 217-773-2832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051040086
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: