Healthcare Provider Details

I. General information

NPI: 1457215212
Provider Name (Legal Business Name): GREGORY WENDEL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 7TH AVE
FORT WORTH TX
76104-2796
US

IV. Provider business mailing address

15108 RODERICK RD
ALEDO TX
76008-1465
US

V. Phone/Fax

Practice location:
  • Phone: 682-885-1103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number49639
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: