Provider Demographics
NPI:1629177043
Name:ELAM, WENDY WHEATLEY (PHARM D, RPH)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:WHEATLEY
Last Name:ELAM
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6494 THIMBLEWEED LANE NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341
Mailing Address - Country:US
Mailing Address - Phone:616-863-0037
Mailing Address - Fax:
Practice Address - Street 1:GRAND RAPIDS VA OUTPATIENT CLINIC
Practice Address - Street 2:3019 COIT AVE NE
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505
Practice Address - Country:US
Practice Address - Phone:616-365-9575
Practice Address - Fax:616-365-9487
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist