Provider Demographics
NPI:1508139205
Name:WENTZEL, JEAN A (RPH)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:WENTZEL
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:PO BOX 11870
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59719-1870
Mailing Address - Country:US
Mailing Address - Phone:406-586-2372
Mailing Address - Fax:
Practice Address - Street 1:2505 CATRON ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7993
Practice Address - Country:US
Practice Address - Phone:406-585-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-12
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3898183500000X
PARP029590L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist