Healthcare Provider Details

I. General information

NPI: 1568401941
Provider Name (Legal Business Name): WENJEST CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10011 SE 15TH ST
MIDWEST CITY OK
73130-5625
US

IV. Provider business mailing address

10011 SE 15TH ST
MIDWEST CITY OK
73130-5625
US

V. Phone/Fax

Practice location:
  • Phone: 405-737-8100
  • Fax: 405-733-1604
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1-5210
License Number StateOK

VIII. Authorized Official

Name: JULIE WILLIS
Title or Position: PHARMACY SUPERVISOR
Credential: RPH
Phone: 405-473-0094