Provider Demographics
NPI:1588188908
Name:GERKEN, WENDY WATKINS (RPH)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:WATKINS
Last Name:GERKEN
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 1:600 COASTAL VILLAGE DR RM 107
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-1973
Mailing Address - Country:US
Mailing Address - Phone:912-574-4210
Mailing Address - Fax:912-217-6234
Practice Address - Street 1:600 COASTAL VILLAGE DR RM 107
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1973
Practice Address - Country:US
Practice Address - Phone:912-574-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist