Provider Demographics
NPI:1811047350
Name:OLESON, DEEANN WEDEMEYER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEEANN
Middle Name:WEDEMEYER
Last Name:OLESON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:DEEANN
Other - Middle Name:
Other - Last Name:WEDEMEYER-OLESON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:700 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50115-1242
Mailing Address - Country:US
Mailing Address - Phone:641-332-3808
Mailing Address - Fax:641-332-2702
Practice Address - Street 1:710 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115-1544
Practice Address - Country:US
Practice Address - Phone:641-332-3808
Practice Address - Fax:641-332-2702
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA192351835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0600189Medicaid