Healthcare Provider Details

I. General information

NPI: 1851995377
Provider Name (Legal Business Name): WENDY HEGE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7935 BROOKVILLE RD
INDIANAPOLIS IN
46239-1085
US

IV. Provider business mailing address

7935 BROOKVILLE RD
INDIANAPOLIS IN
46239-1085
US

V. Phone/Fax

Practice location:
  • Phone: 317-353-0783
  • Fax:
Mailing address:
  • Phone: 317-353-0783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26019228A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: