Provider Demographics
NPI:1083210603
Name:WHEELER, KATHLEEN CLARA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CLARA
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WELLS PLZ
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-4126
Mailing Address - Country:US
Mailing Address - Phone:207-646-2622
Mailing Address - Fax:
Practice Address - Street 1:107 WELLS PLZ
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-4126
Practice Address - Country:US
Practice Address - Phone:207-646-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEBS2239526OtherDEA NUMBER FOR HANNAFORD 8389