Healthcare Provider Details

I. General information

NPI: 1114337086
Provider Name (Legal Business Name): JONATHAN CHARLES BADGER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 E CALUMET ST
APPLETON WI
54915-4149
US

IV. Provider business mailing address

955 N MUTUAL WAY
APPLETON WI
54913-8415
US

V. Phone/Fax

Practice location:
  • Phone: 920-996-0746
  • Fax:
Mailing address:
  • Phone: 920-954-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15914-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: