Provider Demographics
NPI:1639425507
Name:WESSEL, LOUIS E (RPH)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:E
Last Name:WESSEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 N 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9456
Mailing Address - Country:US
Mailing Address - Phone:509-457-1628
Mailing Address - Fax:
Practice Address - Street 1:1207 N 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-9456
Practice Address - Country:US
Practice Address - Phone:509-457-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00017948183500000X
WY2493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist