Individual
TANIA RAE WIESELER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
410 S 5TH ST STE P1, MANKATO, MN 56001
(507) 550-1063
(507) 625-7894
Mailing address
600 STATE ST N, WASECA, MN 56093-2814
(605) 261-4933
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
120255
MN
183500000X
Pharmacist
5270
SD
Other
Enumeration date
04/18/2007
Last updated
07/29/2019
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