| Doctor Name: | DEAN A WALLENTINE |
| NPI Number: | 1265425433 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHARM D. |
| License Number: | P5441 |
| Business Practice Address: | 836 Washington St Montpelier, ID - 832541423 |
| Business Phone Number: | 2088471421 |
| Business Fax Number: | 2088471690 |
| Mailing Address: | 836 Washington St, MONTPELIER |
| State: | ID |
| Postal Code: | 832541423 |
| Phone Number: | 2088471421 |
| Fax Number: | 2088471690 |
| NPI Enumeration Date: | 08/23/2005 |
| NPI Last Update Date: | 04/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | P5441 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |