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General NPI Number Information
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NPI Number | 1902382195
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Entity Type | Individual
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Provider Name | DANIEL JAY WESSEL RPH
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Gender | Male
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 4860 HONONEGAH RD
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City | ROSCOE
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State | IL
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Zip | 61073-7777
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Country | US
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Telephone | 815-623-7798
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Fax | 815-623-9479
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Provider Business Mailing Address
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Address Line | 4125 AUTUMN LN
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City | FREEPORT
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State | IL
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Zip | 61032-8639
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Country | US
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Telephone | 815-233-5860
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051033107
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License Number State | IL
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