Provider Demographics
NPI:1306210299
Name:GRAGES, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:GRAGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PARK DR
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-5639
Mailing Address - Country:US
Mailing Address - Phone:507-451-1771
Mailing Address - Fax:507-774-3008
Practice Address - Street 1:301 PARK DR
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5639
Practice Address - Country:US
Practice Address - Phone:507-451-1771
Practice Address - Fax:507-774-3008
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN733781183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician