Provider Demographics
NPI:1487884565
Name:WIEMERS, ONIS CORWIN (RPH)
Entity type:Individual
Prefix:MR
First Name:ONIS
Middle Name:CORWIN
Last Name:WIEMERS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S TEEL DR
Mailing Address - Street 2:P.O.DRAWER-R
Mailing Address - City:DEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:78016-3210
Mailing Address - Country:US
Mailing Address - Phone:830-663-2224
Mailing Address - Fax:830-665-3053
Practice Address - Street 1:200 S TEEL DR
Practice Address - Street 2:P.O. DRAWER-R
Practice Address - City:DEVINE
Practice Address - State:TX
Practice Address - Zip Code:78016-3210
Practice Address - Country:US
Practice Address - Phone:830-663-2224
Practice Address - Fax:830-665-3053
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist