Healthcare Provider Details

I. General information

NPI: 1295653749
Provider Name (Legal Business Name): HANNAH LYNN WEIDNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 39TH AVE
KENOSHA WI
53144-2043
US

IV. Provider business mailing address

9648 49TH CT
PLEASANT PRAIRIE WI
53158-6537
US

V. Phone/Fax

Practice location:
  • Phone: 262-658-8124
  • Fax: 262-564-8667
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23520
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: