Healthcare Provider Details

I. General information

NPI: 1396234399
Provider Name (Legal Business Name): MS. SHANNA ZWANZIGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E EUCLID AVE
INDIANOLA IA
50125-1816
US

IV. Provider business mailing address

208 E EUCLID AVE
INDIANOLA IA
50125-1816
US

V. Phone/Fax

Practice location:
  • Phone: 515-961-5303
  • Fax: 515-961-5964
Mailing address:
  • Phone: 515-961-5303
  • Fax: 515-961-5964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19096
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: