Provider Demographics
NPI:1407454457
Name:STETTNER, WES ETHAN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:WES
Middle Name:ETHAN
Last Name:STETTNER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 COUNTY ROAD 15 SW
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-4006
Mailing Address - Country:US
Mailing Address - Phone:218-770-3966
Mailing Address - Fax:
Practice Address - Street 1:3001 E HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-4556
Practice Address - Country:US
Practice Address - Phone:320-269-5496
Practice Address - Fax:320-269-8575
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist