Provider Demographics
NPI:1811009293
Name:NULL, WENDY LOU (RPH)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LOU
Last Name:NULL
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 1:1310 PALOMINO AVE
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-9402
Mailing Address - Country:US
Mailing Address - Phone:937-264-0909
Mailing Address - Fax:
Practice Address - Street 1:1 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2024
Practice Address - Country:US
Practice Address - Phone:937-531-3352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-18854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist