Provider Demographics
NPI:1891368528
Name:WEDEMEYER, RACHEL MAY (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MAY
Last Name:WEDEMEYER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 VALLEY VIEW DR S APT 205
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1526
Mailing Address - Country:US
Mailing Address - Phone:712-297-0283
Mailing Address - Fax:
Practice Address - Street 1:3305 CENTRAL PARK VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-7707
Practice Address - Country:US
Practice Address - Phone:651-406-8860
Practice Address - Fax:651-406-8870
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist