Provider Demographics
NPI:1558635326
Name:WESSELS, MARCIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:WESSELS
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:PO BOX 738
Mailing Address - Street 2:340 PEAK ONE DRIVE PHARMACY
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443
Mailing Address - Country:US
Mailing Address - Phone:970-668-6997
Mailing Address - Fax:970-668-6987
Practice Address - Street 1:340 PEAK ONE DRIVE
Practice Address - Street 2:PHARMACY
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-6997
Practice Address - Fax:970-668-6987
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist