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General NPI Number Information
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NPI Number | 1104371707
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Entity Type | Individual
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Provider Name | DARLENE WIEGAND RPH-PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 2300 WESTERN AVE
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City | MANITOWOC
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State | WI
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Zip | 54220-3712
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Country | US
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Telephone | 920-320-2274
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Fax | 920-320-5103
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Provider Business Mailing Address
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Address Line | PO BOX 1450
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City | MANITOWOC
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State | WI
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Zip | 54221-1450
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Country | US
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Telephone | 920-320-2274
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Fax | 920-320-5103
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16674-40
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License Number State | WI
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