Provider Demographics
NPI:1932721966
Name:SPEAKE, WENDAL GENE (RPH)
Entity Type:Individual
Prefix:MR
First Name:WENDAL
Middle Name:GENE
Last Name:SPEAKE
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 1:906 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50441-2217
Mailing Address - Country:US
Mailing Address - Phone:641-425-5561
Mailing Address - Fax:
Practice Address - Street 1:104 1ST ST NW
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50441-1702
Practice Address - Country:US
Practice Address - Phone:641-456-2510
Practice Address - Fax:641-456-4984
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist