Healthcare Provider Details

I. General information

NPI: 1255613147
Provider Name (Legal Business Name): MADELEINE F WHEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 RENO HWY
FALLON NV
89406-2627
US

IV. Provider business mailing address

2020 RENO HWY
FALLON NV
89406-2627
US

V. Phone/Fax

Practice location:
  • Phone: 775-428-6409
  • Fax: 775-428-2826
Mailing address:
  • Phone: 775-428-6409
  • Fax: 775-428-2826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17119
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: