Provider Demographics
NPI:1669506838
Name:ANTENEN, WAYNE (R PH)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:ANTENEN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28023 INDIAN PATH
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-2615
Mailing Address - Country:US
Mailing Address - Phone:830-625-7777
Mailing Address - Fax:
Practice Address - Street 1:345 LANDA ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5439
Practice Address - Country:US
Practice Address - Phone:830-606-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist