Healthcare Provider Details

I. General information

NPI: 1982616488
Provider Name (Legal Business Name): SHANE R WENDEL PHARM.D., B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 4TH AVE S
CARRINGTON ND
58421-2303
US

IV. Provider business mailing address

611 4TH AVE S
CARRINGTON ND
58421-2303
US

V. Phone/Fax

Practice location:
  • Phone: 701-652-2044
  • Fax:
Mailing address:
  • Phone: 701-652-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4552
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: