Mark Edward Wienke, R.PH., CGP

Primary specialty

Geriatric PharmacistTaxonomy code 1835G0303X

License

041282 Issued in MO

Practice address

4112 Fall Ridge Dr
Columbia, MO 65203-6629

Phone

(573) 446-0616

NPI assigned

Oct 10, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318204800000",
    "number": "1548544422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4112 FALL RIDGE DR",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652036629",
            "telephone_number": "573-446-0616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4112 FALL RIDGE DR",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652036629",
            "telephone_number": "573-446-0616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIENKE",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "R.PH., CGP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-10",
        "last_updated": "2011-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "041282",
            "primary": false
        },
        {
            "code": "1835G0303X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Geriatric",
            "state": "MO",
            "license": "041282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Pharmacist in Columbia, MO
• Providers in Columbia, MO by specialty
• Geriatric Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.