Provider Demographics
NPI:1255613147
Name:WHEELER, MADELEINE F
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:F
Last Name:WHEELER
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 1:2020 RENO HWY
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-2627
Mailing Address - Country:US
Mailing Address - Phone:775-428-6409
Mailing Address - Fax:775-428-2826
Practice Address - Street 1:2020 RENO HWY
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2627
Practice Address - Country:US
Practice Address - Phone:775-428-6409
Practice Address - Fax:775-428-2826
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist