Healthcare Provider Details

I. General information

NPI: 1568458552
Provider Name (Legal Business Name): KAREN ELAINE WEIS R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W TOWNLINE ST SUITE 3
CRESTON IA
50801-1054
US

IV. Provider business mailing address

1700 W TOWNLINE ST SUITE 3
CRESTON IA
50801-1054
US

V. Phone/Fax

Practice location:
  • Phone: 641-782-3511
  • Fax: 641-782-3846
Mailing address:
  • Phone: 641-782-3511
  • Fax: 641-782-3846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17197
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: