Healthcare Provider Details

I. General information

NPI: 1679915276
Provider Name (Legal Business Name): SETH LEROY WENNINGER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N WILLIAMS ST
PAULDING OH
45879-1076
US

IV. Provider business mailing address

1000 N WILLIAMS ST
PAULDING OH
45879-1076
US

V. Phone/Fax

Practice location:
  • Phone: 419-399-5348
  • Fax:
Mailing address:
  • Phone: 419-399-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03233069
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: