Active NPI
Lisa Annette Wienclaw, PHARM D
- Pharmacist
- Bettendorf, IA
National Provider Identifier
1093092199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19877
- Practice address
- 830 Middle Rd
Bettendorf, IA 52722-4101 - Phone
- (563) 355-5345
- NPI assigned
- Nov 3, 2011
- Last updated
- Nov 3, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19877 | IA | Primary |
Addresses
Primary practice location
830 Middle Rd
Bettendorf, IA 52722-4101
Mailing address
3220 Greenbrier Dr
Bettendorf, IA 52722-2522
Phone (319) 321-5472
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19877 | Other | IA | PHARMACY LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19877 | IA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320278400000",
"number": "1093092199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3220 GREENBRIER DR",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527222522",
"telephone_number": "319-321-5472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 MIDDLE RD",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527224101",
"telephone_number": "563-355-5345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIENCLAW",
"first_name": "LISA",
"middle_name": "ANNETTE",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-03",
"last_updated": "2011-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "19877",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY LICENSE",
"identifier": "19877",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bettendorf, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.