Provider Demographics
NPI:1164028247
Name:WEHKING, CALEB MICHAEL
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:MICHAEL
Last Name:WEHKING
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 1:325 WOODS LN
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-6243
Mailing Address - Country:US
Mailing Address - Phone:618-322-9577
Mailing Address - Fax:
Practice Address - Street 1:5120 WESTON RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-3702
Practice Address - Country:US
Practice Address - Phone:812-424-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303355183500000X
IN26028840A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist