Provider Demographics
NPI:1982616488
Name:WENDEL, SHANE R (PHARMD, BS)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:R
Last Name:WENDEL
Suffix:
Gender:M
Credentials:PHARMD, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:CARRINGTON
Mailing Address - State:ND
Mailing Address - Zip Code:58421-2303
Mailing Address - Country:US
Mailing Address - Phone:701-652-2044
Mailing Address - Fax:
Practice Address - Street 1:611 4TH AVE S
Practice Address - Street 2:
Practice Address - City:CARRINGTON
Practice Address - State:ND
Practice Address - Zip Code:58421-2303
Practice Address - Country:US
Practice Address - Phone:701-652-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist