Healthcare Provider Details

I. General information

NPI: 1780201764
Provider Name (Legal Business Name): CHRISTOPHER LEE STERN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 E CALUMET ST
APPLETON WI
54915-4127
US

IV. Provider business mailing address

4019 TOWNE LAKES AVE APT 4216
APPLETON WI
54913-8159
US

V. Phone/Fax

Practice location:
  • Phone: 920-733-3016
  • Fax:
Mailing address:
  • Phone: 715-412-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20305-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: