Active NPI
Tristan Wieseler, PHARM.D.
- Pharmacist
- South Sioux City, NE
National Provider Identifier
1376293654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17126
- Practice address
- 2501 Cornhusker Dr
South Sioux City, NE 68776-3910 - Phone
- (402) 494-3021
- NPI assigned
- Mar 28, 2022
- Sex
- Male
- 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 | 17126 | NE | Primary |
Addresses
Primary practice location
2501 Cornhusker Dr
South Sioux City, NE 68776-3910
Mailing address
2501 Cornhusker Dr
South Sioux City, NE 68776-3916
Phone (402) 494-3021
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 |
|---|---|---|---|
| 17126 | NE | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648425600000",
"number": "1376293654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2501 CORNHUSKER DR",
"city": "SOUTH SIOUX CITY",
"state": "NE",
"postal_code": "687763916",
"telephone_number": "402-494-3021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2501 CORNHUSKER DR",
"city": "SOUTH SIOUX CITY",
"state": "NE",
"postal_code": "687763910",
"telephone_number": "402-494-3021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIESELER",
"first_name": "TRISTAN",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-28",
"last_updated": "2022-03-28",
"certification_date": "2022-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NE",
"license": "17126",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Sioux City, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.