Healthcare Provider Details

I. General information

NPI: 1477922029
Provider Name (Legal Business Name): DOUG WENNER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N GOULD ST # 5853
SHERIDAN WY
82801-6317
US

IV. Provider business mailing address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 330-237-9930
  • Fax:
Mailing address:
  • Phone: 571-231-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03439509
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: