MEDICARE: CAMILLE KATHERINE WISSMANN PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051037824	IL
2	183500000X	Pharmacist	29988	ND
3	183500000X	Pharmacist	13629	IA
4	183500000X	Pharmacist	9984	CO
5	183500000X	Pharmacist	10702040	WI

General Provider Information

NPI Number	:	1669448742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE KATHERINE WISSMANN PHARM D

Provider Business Mailing Address
First Line	:	923 W WINDTREE DR
Second Line	:	923 W WINDTREE DRIVE
City	:	APPLETON
State	:	WI
Zip	:	54914-7222
Country	:	US
Telephone Number	:	920-268-7251
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 LARIMER ST
Second Line	:	SUITE 896
City	:	DENVER
State	:	CO
Zip	:	80202-1602
Country	:	US
Telephone Number	:	720-336-1530
Fax Number	:	888-502-0655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	05/03/2011

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