Individual
MR. DAN WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1601 18TH ST, SILVIS, IL 61282-1707
(309) 796-3673
Mailing address
1601 18TH ST, SILVIS, IL 61282-1707
(309) 796-3673
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15231
IA
Other
Enumeration date
10/16/2016
Last updated
10/16/2016
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