Provider Demographics
NPI:1699377531
Name:WENISCH, REID (PHARMD)
Entity Type:Individual
Prefix:
First Name:REID
Middle Name:
Last Name:WENISCH
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 1:819 MARTINGALE DR
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55368-9764
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 S RIVERFRONT DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3773
Practice Address - Country:US
Practice Address - Phone:507-345-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist