Provider Demographics
NPI:1659678159
Name:WIETING, JANCIE LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JANCIE
Middle Name:LYNN
Last Name:WIETING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JANCIE
Other - Middle Name:S
Other - Last Name:HATCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1200 NORTHSIDE FORYSTH DRIVE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041
Mailing Address - Country:US
Mailing Address - Phone:770-844-3396
Mailing Address - Fax:770-844-3397
Practice Address - Street 1:1200 NORTHSIDE FORYSTH DRIVE
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-844-3396
Practice Address - Fax:770-844-3397
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025488183500000X
GARPH025488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist