Provider Demographics
NPI:1922561216
Name:OELMANN, MARY ELIZABETH MOON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH MOON
Last Name:OELMANN
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 1:110 10TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2924
Mailing Address - Country:US
Mailing Address - Phone:319-352-3120
Mailing Address - Fax:319-352-5720
Practice Address - Street 1:110 10TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2924
Practice Address - Country:US
Practice Address - Phone:319-352-3120
Practice Address - Fax:319-352-5720
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist