Healthcare Provider Details

I. General information

NPI: 1235452889
Provider Name (Legal Business Name): TAD SCHILKE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 E AQUAMARINE AVE
APPLETON WI
54913-7205
US

IV. Provider business mailing address

8605 SANTA MONICA BLVD PMB 64914
WEST HOLLYWOOD CA
90069-4109
US

V. Phone/Fax

Practice location:
  • Phone: 608-690-8421
  • Fax: 515-612-9396
Mailing address:
  • Phone: 608-690-8421
  • Fax: 515-612-9396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15224-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: