Healthcare Provider Details

I. General information

NPI: 1619253002
Provider Name (Legal Business Name): CURT JANSSEN PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2011
Last Update Date: 10/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W COLLEGE AVE
APPLETON WI
54914-5265
US

IV. Provider business mailing address

W2012 FINNIGANS RIDGE LN
FREEDOM WI
54130-7187
US

V. Phone/Fax

Practice location:
  • Phone: 920-733-6599
  • Fax:
Mailing address:
  • Phone: 920-562-9791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15538-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: