Provider Demographics
NPI:1902981509
Name:WAECKERLIN, ROD F (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROD
Middle Name:F
Last Name:WAECKERLIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 3RD ST
Mailing Address - Street 2:BOX 697
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5612
Mailing Address - Country:US
Mailing Address - Phone:307-324-3403
Mailing Address - Fax:
Practice Address - Street 1:300 3RD ST
Practice Address - Street 2:BOX 697
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5612
Practice Address - Country:US
Practice Address - Phone:307-324-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY2125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist