Healthcare Provider Details

I. General information

NPI: 1902712102
Provider Name (Legal Business Name): TERRA RENEE WONSETTLER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5615 NETTLECREEK AVE NW
MASSILLON OH
44646-1134
US

IV. Provider business mailing address

5615 NETTLECREEK AVE NW
MASSILLON OH
44646-1134
US

V. Phone/Fax

Practice location:
  • Phone: 330-949-9882
  • Fax:
Mailing address:
  • Phone: 330-949-9882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03328564
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: