Provider Demographics
NPI:1811002355
Name:WENTZEL, DONALD H (R PH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:H
Last Name:WENTZEL
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 DRY LANE RD N
Mailing Address - Street 2:
Mailing Address - City:LA RUE
Mailing Address - State:OH
Mailing Address - Zip Code:43332-9510
Mailing Address - Country:US
Mailing Address - Phone:740-499-3654
Mailing Address - Fax:740-499-3654
Practice Address - Street 1:2005 DRY LANE RD N
Practice Address - Street 2:
Practice Address - City:LA RUE
Practice Address - State:OH
Practice Address - Zip Code:43332-9510
Practice Address - Country:US
Practice Address - Phone:740-499-3654
Practice Address - Fax:740-499-3654
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-08714183500000X
KY11031183500000X
IN26017852183500000X
NC13366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist