Provider Demographics
NPI:1891065272
Name:WHEATLEY, LADONA (RPH)
Entity Type:Individual
Prefix:
First Name:LADONA
Middle Name:
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LADONA
Other - Middle Name:A
Other - Last Name:WHEATLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3710 TWISTED OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3423
Mailing Address - Country:US
Mailing Address - Phone:210-347-4656
Mailing Address - Fax:
Practice Address - Street 1:11603 W COKER LOOP
Practice Address - Street 2:STE. 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2820
Practice Address - Country:US
Practice Address - Phone:210-494-1245
Practice Address - Fax:210-494-4089
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34216183500000X
WI12734-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist