Provider Demographics
NPI:1073950341
Name:WETTENGEL, WILLIAM L (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:L
Last Name:WETTENGEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WOODCLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4288
Mailing Address - Country:US
Mailing Address - Phone:712-256-3836
Mailing Address - Fax:
Practice Address - Street 1:101 WOODCLIFF CIR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4288
Practice Address - Country:US
Practice Address - Phone:712-256-3836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist