Provider Demographics
NPI:1780375535
Name:WUEBBELS, ALICIA LEE (RPH)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LEE
Last Name:WUEBBELS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 E MCCORD ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3044
Mailing Address - Country:US
Mailing Address - Phone:618-533-3300
Mailing Address - Fax:618-533-3302
Practice Address - Street 1:817 E MCCORD ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3044
Practice Address - Country:US
Practice Address - Phone:618-533-3300
Practice Address - Fax:618-533-3302
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051286667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist