Provider Demographics
NPI:1467732164
Name:WENZELL, SHELLI M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHELLI
Middle Name:M
Last Name:WENZELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26036 COX RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-6566
Mailing Address - Country:US
Mailing Address - Phone:804-863-4922
Mailing Address - Fax:804-863-4928
Practice Address - Street 1:26036 COX RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-6566
Practice Address - Country:US
Practice Address - Phone:804-863-4922
Practice Address - Fax:804-863-4928
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist