Provider Demographics
NPI:1477733954
Name:WIEWEL, TRECIA GLEE (RPH)
Entity Type:Individual
Prefix:
First Name:TRECIA
Middle Name:GLEE
Last Name:WIEWEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-2922
Mailing Address - Country:US
Mailing Address - Phone:218-829-3664
Mailing Address - Fax:218-829-8979
Practice Address - Street 1:218 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-2922
Practice Address - Country:US
Practice Address - Phone:218-829-3664
Practice Address - Fax:218-829-8979
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist