Provider Demographics
NPI:1629859715
Name:WISER, AUSTIN THOMAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:THOMAS
Last Name:WISER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7305
Mailing Address - Country:US
Mailing Address - Phone:515-681-5265
Mailing Address - Fax:
Practice Address - Street 1:3625 N ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4610
Practice Address - Country:US
Practice Address - Phone:515-965-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist