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Individual

MR. MARK EDWARD WIENKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
R.PH., CGP

Contact information

Practice address
4112 FALL RIDGE DR, COLUMBIA, MO 65203-6629
(573) 446-0616
Mailing address
4112 FALL RIDGE DR, COLUMBIA, MO 65203-6629
(573) 446-0616

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
041282
MO
1835G0303X
Geriatric Pharmacist
Primary
041282
MO

Other

Enumeration date
10/10/2011
Last updated
10/10/2011
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