Provider Demographics
NPI:1396234399
Name:ZWANZIGER, SHANNA
Entity type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:
Last Name:ZWANZIGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-1816
Mailing Address - Country:US
Mailing Address - Phone:515-961-5303
Mailing Address - Fax:515-961-5964
Practice Address - Street 1:208 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-1816
Practice Address - Country:US
Practice Address - Phone:515-961-5303
Practice Address - Fax:515-961-5964
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist