Provider Demographics
NPI:1730457367
Name:WETZEL, ERIN BETH (PHARM D, RPH)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:BETH
Last Name:WETZEL
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 1:1 BUCK GROVE EST
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-9335
Mailing Address - Country:US
Mailing Address - Phone:217-235-1408
Mailing Address - Fax:217-234-3675
Practice Address - Street 1:212 S LOGAN AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4595
Practice Address - Country:US
Practice Address - Phone:217-235-3126
Practice Address - Fax:217-234-3675
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.286754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist