Provider Demographics
NPI:1225219496
Name:WENDEL, LOUISE STEFFAN (RPH)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:STEFFAN
Last Name:WENDEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:LOUISE
Other - Middle Name:ANNE
Other - Last Name:STEFFAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:6090 PETH RD
Mailing Address - Street 2:
Mailing Address - City:GREAT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14741-9781
Mailing Address - Country:US
Mailing Address - Phone:716-945-8611
Mailing Address - Fax:
Practice Address - Street 1:2801 W STATE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1828
Practice Address - Country:US
Practice Address - Phone:716-373-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035603-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist