Provider Demographics
NPI:1396012670
Name:WETZLER, MIKI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MIKI
Middle Name:
Last Name:WETZLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-8131
Mailing Address - Country:US
Mailing Address - Phone:408-991-9013
Mailing Address - Fax:408-991-9025
Practice Address - Street 1:103 E EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-8131
Practice Address - Country:US
Practice Address - Phone:408-991-9013
Practice Address - Fax:408-991-9025
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist