Provider Demographics
NPI:1568730802
Name:SAN DIEGO, WENDY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:SAN DIEGO
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 1:3 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2438
Mailing Address - Country:US
Mailing Address - Phone:618-741-7968
Mailing Address - Fax:
Practice Address - Street 1:7398 N LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2033
Practice Address - Country:US
Practice Address - Phone:314-972-1257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010037355183500000X
IL051294641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist