Provider Demographics
NPI:1104195403
Name:WENSINK, AARON
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:WENSINK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 BURNT STORE RD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1708
Mailing Address - Country:US
Mailing Address - Phone:239-690-4939
Mailing Address - Fax:239-282-0834
Practice Address - Street 1:611 BURNT STORE RD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1708
Practice Address - Country:US
Practice Address - Phone:239-690-4939
Practice Address - Fax:239-282-0834
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist