Healthcare Provider Details

I. General information

NPI: 1336938554
Provider Name (Legal Business Name): WENDY HUANG
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5780 FRANKLIN ST
MICHIGAN CITY IN
46360-7844
US

IV. Provider business mailing address

5780 FRANKLIN ST
MICHIGAN CITY IN
46360-7844
US

V. Phone/Fax

Practice location:
  • Phone: 219-872-3309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302416922
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26031209A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: