Healthcare Provider Details

I. General information

NPI: 1811272024
Provider Name (Legal Business Name): JOSEPH RANDALL WOHLSTADTER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 SOUTH TRUMAN BLVD.
FESTUS MO
63029
US

IV. Provider business mailing address

519 SOUTH TRUMAN BLVD.
FESTUS MO
63029
US

V. Phone/Fax

Practice location:
  • Phone: 636-937-3641
  • Fax: 636-937-6124
Mailing address:
  • Phone: 636-937-3641
  • Fax: 636-937-6124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number028612
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: