Provider Demographics
NPI:1588042394
Name:WENSMANN, GERALD (PHARMD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:WENSMANN
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 1:105 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MN
Mailing Address - Zip Code:56352-1159
Mailing Address - Country:US
Mailing Address - Phone:320-256-4452
Mailing Address - Fax:855-640-3893
Practice Address - Street 1:105 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MN
Practice Address - Zip Code:56352-1159
Practice Address - Country:US
Practice Address - Phone:320-256-4452
Practice Address - Fax:855-640-3893
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist