Individual provider Active NPI

Darlene Wiegand, RPH-PHARMACIST

  • Pharmacist
  • Manitowoc, WI
National Provider Identifier
1104371707
Registry record updated Aug 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
16674-40 Issued in WI
Practice address
2300 Western Ave
Manitowoc, WI 54220-3712
Phone
(920) 320-2274
Fax
(920) 320-5103
NPI assigned
Aug 24, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 16674-40 WI Primary

Addresses

Primary practice location

2300 Western Ave
Manitowoc, WI 54220-3712

Mailing address

PO Box 1450
Manitowoc, WI 54221-1450
Phone (920) 320-2274

Other identifiers 1

IdentifierTypeStateIssuer
33112700MedicaidWI

Other names 1

  • Mrs. Darlene Wiegand Professional name

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

State licenses

LicenseStateTypeSpecialty
16674-40WIMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471996800000",
    "number": "1104371707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1450",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542211450",
            "telephone_number": "920-320-2274",
            "fax_number": "920-320-5103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 WESTERN AVE",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542203712",
            "telephone_number": "920-320-2274",
            "fax_number": "920-320-5103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEGAND",
        "first_name": "DARLENE",
        "credential": "RPH-PHARMACIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-24",
        "last_updated": "2016-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "16674-40",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33112700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DARLENE",
            "last_name": "WIEGAND",
            "prefix": "MRS.",
            "credential": "PHARMACIST",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Manitowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.