Provider Demographics
NPI:1013141365
Name:WHEELOCK PHARMACY, INC
Entity Type:Organization
Organization Name:WHEELOCK PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-263-7175
Mailing Address - Street 1:700 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-3079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1325 N MAIN ST
Practice Address - Street 2:STE H
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1721
Practice Address - Country:US
Practice Address - Phone:517-263-7175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6370480001Medicare NSC