Individual
RUSSELL DUANE WIESLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH, CDM
Contact information
Practice address
4343 MERLE HAY RD, DES MOINES, IA 50310-1411
(515) 276-4845
(515) 331-3163
Mailing address
805 WALNUT RIDGE DR, WAUKEE, IA 50263-9619
(515) 224-0227
(515) 222-9764
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14611
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007559
—
IA
Enumeration date
05/24/2005
Last updated
09/18/2008
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