Provider Demographics
NPI:1295069565
Name:WENTZ, ELISHA E (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ELISHA
Middle Name:E
Last Name:WENTZ
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 1:795 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-3403
Mailing Address - Country:US
Mailing Address - Phone:276-783-4115
Mailing Address - Fax:276-783-1411
Practice Address - Street 1:795 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-3403
Practice Address - Country:US
Practice Address - Phone:276-783-4115
Practice Address - Fax:276-783-1411
Is Sole Proprietor?:No
Enumeration Date:2009-09-19
Last Update Date:2009-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist