Provider Demographics
NPI:1679812614
Name:WEILER-NYTES, KRISTIN LEA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEA
Last Name:WEILER-NYTES
Suffix:
Gender:F
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:N3708 RIVER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-7218
Mailing Address - Country:US
Mailing Address - Phone:715-743-3500
Mailing Address - Fax:715-743-5060
Practice Address - Street 1:N3708 RIVER AVE STE A
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-7218
Practice Address - Country:US
Practice Address - Phone:715-743-3500
Practice Address - Fax:715-743-5060
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16014-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI16014OtherLICENSE