Provider Demographics
NPI:1790789691
Name:DUNN, WESLEY (RPH)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:DUNN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11909 COUNTY ROAD 1622
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:MO
Mailing Address - Zip Code:64485-9704
Mailing Address - Country:US
Mailing Address - Phone:816-324-4099
Mailing Address - Fax:816-324-6429
Practice Address - Street 1:102 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:MO
Practice Address - Zip Code:64485-1644
Practice Address - Country:US
Practice Address - Phone:816-324-5955
Practice Address - Fax:816-324-6429
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043807183500000X
KS1-11908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO358773000Medicaid