Provider Demographics
NPI:1760061030
Name:WUENSCHE, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WUENSCHE
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 1:426 NELDA ST
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-7417
Mailing Address - Country:US
Mailing Address - Phone:361-522-1189
Mailing Address - Fax:
Practice Address - Street 1:2401 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-5704
Practice Address - Country:US
Practice Address - Phone:361-729-9841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist