Provider Demographics
NPI:1255003737
Name:WHEELER, JAMES DWAYNE JR
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DWAYNE
Last Name:WHEELER
Suffix:JR
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 1:1124 N BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-7516
Mailing Address - Country:US
Mailing Address - Phone:810-233-6765
Mailing Address - Fax:810-233-6582
Practice Address - Street 1:1124 N BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-7516
Practice Address - Country:US
Practice Address - Phone:810-233-6765
Practice Address - Fax:810-233-6582
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303025678183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician