Provider Demographics
NPI:1578658787
Name:WIEST, DONNA MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:WIEST
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 1:712 GOOSE NECK DR.
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543
Mailing Address - Country:US
Mailing Address - Phone:717-569-2732
Mailing Address - Fax:717-295-5429
Practice Address - Street 1:LIFECARE PHARMACY
Practice Address - Street 2:2106 HARRISBURG PK.
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17604
Practice Address - Country:US
Practice Address - Phone:717-544-3154
Practice Address - Fax:717-544-3166
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032531L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist