Provider Demographics
NPI:1770683708
Name:VANWIE, WAYNE DOUGLAS (PD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:DOUGLAS
Last Name:VANWIE
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4254
Mailing Address - Country:US
Mailing Address - Phone:410-719-0932
Mailing Address - Fax:410-391-3922
Practice Address - Street 1:9106 PHILADELPHIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4329
Practice Address - Country:US
Practice Address - Phone:410-687-8113
Practice Address - Fax:410-391-3922
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1457394108OtherPHARMACY NPI