Healthcare Provider Details

I. General information

NPI: 1134774987
Provider Name (Legal Business Name): MEREDITH WYLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E 9TH ST STE A
CORALVILLE IA
52241-2209
US

IV. Provider business mailing address

200 HAWKINS DR # CC101GH
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-467-2344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23674
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: