Provider Demographics
NPI:1932136710
Name:WIELAND, THOMAS DALE (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DALE
Last Name:WIELAND
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2464 SYMPHONY LN
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1579
Mailing Address - Country:US
Mailing Address - Phone:410-672-5881
Mailing Address - Fax:410-672-5881
Practice Address - Street 1:5507 RITCHIE HWY STE B
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-3472
Practice Address - Country:US
Practice Address - Phone:410-355-3610
Practice Address - Fax:410-355-7248
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist