Individual
LISA ANNETTE WIENCLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
830 MIDDLE RD, BETTENDORF, IA 52722-4101
(563) 355-5345
Mailing address
3220 GREENBRIER DR, BETTENDORF, IA 52722-2522
(319) 321-5472
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
19877
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19877
PHARMACY LICENSE
IA
Enumeration date
11/03/2011
Last updated
11/03/2011
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