Provider Demographics
NPI:1467445692
Name:WESNITZER, RANDY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:WESNITZER
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 1:4111 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4450
Mailing Address - Country:US
Mailing Address - Phone:307-577-2379
Mailing Address - Fax:307-577-2039
Practice Address - Street 1:1222 E 2ND ST
Practice Address - Street 2:ATTN PHARMACY
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2927
Practice Address - Country:US
Practice Address - Phone:307-577-2331
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist