Individual
DR. ANDREW D WHEATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1029 TANA LN, MENASHA, WI 54952-2960
(920) 882-9241
Mailing address
1029 TANA LN, MENASHA, WI 54952-2960
(920) 882-9241
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14490-040
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14490-040
STATE LICENSE
WI
Enumeration date
04/27/2012
Last updated
04/27/2012
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