Provider Demographics
NPI:1689270548
Name:WELLNITZ, ARTHUR ROBERT
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:ROBERT
Last Name:WELLNITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1722
Mailing Address - Country:US
Mailing Address - Phone:715-246-2186
Mailing Address - Fax:844-207-0451
Practice Address - Street 1:110 W 4TH ST
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1722
Practice Address - Country:US
Practice Address - Phone:715-246-2186
Practice Address - Fax:844-207-0451
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8958-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist