Provider Demographics
NPI:1083720742
Name:MC DADE, WENDY LOUISE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LOUISE
Last Name:MC DADE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11825 OCEAN VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89441
Mailing Address - Country:US
Mailing Address - Phone:775-424-6682
Mailing Address - Fax:775-328-1838
Practice Address - Street 1:1000 LOCUST ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2597
Practice Address - Country:US
Practice Address - Phone:775-328-1840
Practice Address - Fax:775-328-1838
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist