Healthcare Provider Details

I. General information

NPI: 1447976733
Provider Name (Legal Business Name): KIAH WESELI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/16/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 WI 70
WEBSTER WI
54893-8206
US

IV. Provider business mailing address

23423 BIRCH RD
SIREN WI
54872-8440
US

V. Phone/Fax

Practice location:
  • Phone: 715-866-8644
  • Fax:
Mailing address:
  • Phone: 763-742-2445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21344-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: