Healthcare Provider Details

I. General information

NPI: 1104813120
Provider Name (Legal Business Name): KATHY WESSLING RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W 4TH ST
VINTON IA
52349-1121
US

IV. Provider business mailing address

5759 22ND AVENUE DR
VINTON IA
52349-9436
US

V. Phone/Fax

Practice location:
  • Phone: 319-472-4274
  • Fax:
Mailing address:
  • Phone: 319-472-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15136
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: