Provider Demographics
NPI:1003154741
Name:WILTFANG, PAMELA F (PHARMD, MPH, BA)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:F
Last Name:WILTFANG
Suffix:
Gender:F
Credentials:PHARMD, MPH, BA
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:F
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD/MPH
Mailing Address - Street 1:1150 5TH ST
Mailing Address - Street 2:STE 140
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2932
Mailing Address - Country:US
Mailing Address - Phone:319-594-6082
Mailing Address - Fax:319-354-6050
Practice Address - Street 1:1900 JAMES ST STE 10
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1895
Practice Address - Country:US
Practice Address - Phone:319-594-6082
Practice Address - Fax:319-354-6050
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist