Provider Demographics
NPI:1134720253
Name:WOEBKENBERG, JON ADAM (PHARMD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:ADAM
Last Name:WOEBKENBERG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 DECATUR CT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-9289
Mailing Address - Country:US
Mailing Address - Phone:812-568-5819
Mailing Address - Fax:
Practice Address - Street 1:2700 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-9418
Practice Address - Country:US
Practice Address - Phone:812-386-6690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020449A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist