Provider Demographics
NPI:1790855328
Name:WHEELER, DEWANNA DESHA (RPH)
Entity Type:Individual
Prefix:
First Name:DEWANNA
Middle Name:DESHA
Last Name:WHEELER
Suffix:
Gender:F
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:PO BOX 815
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GAP
Mailing Address - State:TX
Mailing Address - Zip Code:79508-0815
Mailing Address - Country:US
Mailing Address - Phone:325-672-7444
Mailing Address - Fax:
Practice Address - Street 1:1857 PINE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2429
Practice Address - Country:US
Practice Address - Phone:325-670-4545
Practice Address - Fax:325-670-2896
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143925Medicaid
TX4588060OtherNABP NUMBER
TX143925Medicaid