1598161960 NPI number — MR. GREGG WENDLAND RPH.

Table of content: MR. GREGG WENDLAND RPH. (NPI 1598161960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598161960 NPI number — MR. GREGG WENDLAND RPH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WENDLAND
Provider First Name:
GREGG
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598161960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1232 UNIVERSITY OF OREGON
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97403-1205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-346-4454
Provider Business Mailing Address Fax Number:
541-346-2749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1590 E, 13TH AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-346-4454
Provider Business Practice Location Address Fax Number:
541-346-2749
Provider Enumeration Date:
11/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  0008535 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1835P0018X , with the licence number: RPH-0008535-P , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RPH-0008535-P . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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