Provider Demographics
NPI:1639492960
Name:WEHNER, DOUGLAS G (RPH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:G
Last Name:WEHNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5015
Mailing Address - Country:US
Mailing Address - Phone:785-843-5474
Mailing Address - Fax:
Practice Address - Street 1:3510 CLINTON PKWY PL
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2195
Practice Address - Country:US
Practice Address - Phone:785-842-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-9410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist