Provider Demographics
NPI:1982047403
Name:BECHTOLT, WENDY S (RPH)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:BECHTOLT
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:BANKS
Mailing Address - State:OR
Mailing Address - Zip Code:97106-0129
Mailing Address - Country:US
Mailing Address - Phone:503-324-5780
Mailing Address - Fax:503-324-5410
Practice Address - Street 1:12350 NW MAIN ST
Practice Address - Street 2:B
Practice Address - City:BANKS
Practice Address - State:OR
Practice Address - Zip Code:97106-9045
Practice Address - Country:US
Practice Address - Phone:503-324-5780
Practice Address - Fax:503-324-5410
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist