Provider Demographics
NPI:1255617387
Name:WIELER, RICHARD DAVID
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:WIELER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 N 160TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2403
Mailing Address - Country:US
Mailing Address - Phone:402-498-3734
Mailing Address - Fax:
Practice Address - Street 1:18040 R PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1922
Practice Address - Country:US
Practice Address - Phone:402-408-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112174183500000X
IA19243183500000X
NE11548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist