Provider Demographics
NPI:1366565137
Name:WACKER, CASON WILLIAM (PHARM D)
Entity type:Individual
Prefix:MR
First Name:CASON
Middle Name:WILLIAM
Last Name:WACKER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ROSEDALE DR
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213-9377
Mailing Address - Country:US
Mailing Address - Phone:319-849-1655
Mailing Address - Fax:
Practice Address - Street 1:1556 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5124
Practice Address - Country:US
Practice Address - Phone:319-366-2239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist