Provider Demographics
NPI:1215523220
Name:WOUR, DENG MALOU
Entity type:Individual
Prefix:
First Name:DENG
Middle Name:MALOU
Last Name:WOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4528 ASHWORTH DR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-8037
Mailing Address - Country:US
Mailing Address - Phone:515-778-0210
Mailing Address - Fax:
Practice Address - Street 1:525 BRANDILYNN BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-7415
Practice Address - Country:US
Practice Address - Phone:319-277-7793
Practice Address - Fax:319-277-6665
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist