Provider Demographics
NPI:1770771735
Name:WENZELL, RONALD CRAIG (RPH)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:CRAIG
Last Name:WENZELL
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 1:550 GLEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2450
Mailing Address - Country:US
Mailing Address - Phone:440-537-1948
Mailing Address - Fax:
Practice Address - Street 1:550 GLEN PARK DR
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2450
Practice Address - Country:US
Practice Address - Phone:440-537-1948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-12164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist