Provider Demographics
NPI:1811593478
Name:WENZEL, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WENZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14133 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8462
Mailing Address - Country:US
Mailing Address - Phone:218-855-0880
Mailing Address - Fax:218-855-0010
Practice Address - Street 1:14133 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8462
Practice Address - Country:US
Practice Address - Phone:218-855-0880
Practice Address - Fax:218-855-0010
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy