MEDICARE: STEVIE WESSEL PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	73719	CA

General Provider Information

NPI Number	:	1144693912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVIE WESSEL PHARMD

Provider Business Mailing Address
First Line	:	9390 DESCHUTES RD
Second Line	:
City	:	PALO CEDRO
State	:	CA
Zip	:	96073-9763
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9390 DESCHUTES RD
Second Line	:
City	:	PALO CEDRO
State	:	CA
Zip	:	96073-9763
Country	:	US
Telephone Number	:	530-547-4403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	11/02/2015

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