Provider Demographics
NPI:1831912641
Name:SOREL, WYATT EDWARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WYATT
Middle Name:EDWARD
Last Name:SOREL
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 1:7438 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54893-8215
Mailing Address - Country:US
Mailing Address - Phone:715-866-8644
Mailing Address - Fax:
Practice Address - Street 1:7438 MAIN ST W
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893-8215
Practice Address - Country:US
Practice Address - Phone:715-866-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22771-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist