Provider Demographics
NPI:1417546094
Name:ZWEBER, MARY BEATA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BEATA
Last Name:ZWEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13711 47TH STREET CT N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-1239
Mailing Address - Country:US
Mailing Address - Phone:612-384-1411
Mailing Address - Fax:
Practice Address - Street 1:13711 47TH STREET CT N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-1239
Practice Address - Country:US
Practice Address - Phone:612-384-1411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist