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General NPI Number Information
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NPI Number | 1235370404
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Entity Type | Individual
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Provider Name | WENDY ANN WASSON CPHT
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Gender | Female
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 2104 MASSEY AVE NAVAL STATION MAYPORT
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City | MAYPORT
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State | FL
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Zip | 32227
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Country | US
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Telephone | 904-270-4205
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Fax | 904-270-4454
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Provider Business Mailing Address
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Address Line | 12590 BLUE LAGOON TRL
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City | JACKSONVILLE
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State | FL
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Zip | 32225-5223
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Country | US
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Telephone | 904-982-9740
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 140103449279957
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | 140103449279957
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License Number State | FL
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