Provider Demographics
NPI:1447976733
Name:WESELI, KIAH (PHARMD)
Entity type:Individual
Prefix:
First Name:KIAH
Middle Name:
Last Name:WESELI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23423 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-8440
Mailing Address - Country:US
Mailing Address - Phone:763-742-2445
Mailing Address - Fax:
Practice Address - Street 1:4404 WI 70
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893-8206
Practice Address - Country:US
Practice Address - Phone:715-866-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21344-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist