Provider Demographics
NPI:1942781851
Name:WEELDREYER, PAIGE NICOLE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:NICOLE
Last Name:WEELDREYER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:PAIGE
Other - Middle Name:NICOLE
Other - Last Name:HARALDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:925 EGLIN ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-9567
Mailing Address - Country:US
Mailing Address - Phone:605-877-3103
Mailing Address - Fax:
Practice Address - Street 1:925 EGLIN ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-9567
Practice Address - Country:US
Practice Address - Phone:605-877-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist