Provider Demographics
NPI:1104302975
Name:WIESZCZYK, DEANNE JOAN (RPH)
Entity type:Individual
Prefix:
First Name:DEANNE
Middle Name:JOAN
Last Name:WIESZCZYK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:DEANNE
Other - Middle Name:JOAN
Other - Last Name:KLINGENSMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:332 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:16242-1004
Mailing Address - Country:US
Mailing Address - Phone:814-275-3424
Mailing Address - Fax:
Practice Address - Street 1:332 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:16242-1004
Practice Address - Country:US
Practice Address - Phone:814-275-3424
Practice Address - Fax:814-275-3428
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031807L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist