Wiesley, Russell Duane

Wiesley, Russell Duane is an individual health care provider with primary practice located at 4343 Merle Hay Rd , Des Moines IA 50310-1411. He recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as his primary health care specialty. Wiesley, Russell Duane can be contacted via phone (515) 276-4845.

Contact Information

Primary practice address
4343 Merle Hay Rd Des Moines IA 50310-1411
Phone: (515) 276-4845
Fax: (515) 331-3163
Website:
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Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X 14611 Iowa

Profile Details

NPI number 1295738102
LBN Legal business name Wiesley, Russell Duane
Credentials RPH, CDM
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2005
Last updated Sep 18th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295738102 NPPES
Iowa MEDICAID 0007559

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