Provider Demographics
NPI:1447999578
Name:WASMUTH, MICHELE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:WASMUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 SEQUOIA DRIVE
Mailing Address - Street 2:APARTMENT 206B
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109
Mailing Address - Country:US
Mailing Address - Phone:814-363-1098
Mailing Address - Fax:
Practice Address - Street 1:4507 SEQUOIA DR APT B206
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-6404
Practice Address - Country:US
Practice Address - Phone:814-363-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43418OtherPHARMACY
PARP453120OtherPHARMACY
OH36236591OtherOHIO