Provider Demographics
NPI:1275767832
Name:WUEBKERS, DOREEN MARIE
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:MARIE
Last Name:WUEBKERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:MARIE
Other - Last Name:MILLION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1502 LONDON ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812
Mailing Address - Country:US
Mailing Address - Phone:218-733-1110
Mailing Address - Fax:218-733-1112
Practice Address - Street 1:1502 LONDON ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812
Practice Address - Country:US
Practice Address - Phone:218-733-1110
Practice Address - Fax:218-733-1112
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN706909183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician