Thomas Wennergren, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

S019997 Issued in AZ

Practice address

25 S Lake Havasu Ave
Lake Havasu City, AZ 86403

Phone

(801) 694-4241

NPI assigned

Apr 9, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461888000000",
    "number": "1750700589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 LAKE HAVASU AVE S",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 S LAKE HAVASU AVE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "86403",
            "telephone_number": "801-694-4241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENNERGREN",
        "first_name": "THOMAS",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-09",
        "last_updated": "2016-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "S019997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Pharmacist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2016; 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.