Provider Demographics
NPI:1760086961
Name:WEITZEL, JOANNA LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:LYNN
Last Name:WEITZEL
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 1:3030 S CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4909
Mailing Address - Country:US
Mailing Address - Phone:417-881-1494
Mailing Address - Fax:417-881-1755
Practice Address - Street 1:3030 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4909
Practice Address - Country:US
Practice Address - Phone:417-881-1494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000172851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist