Healthcare Provider Details

I. General information

NPI: 1952901712
Provider Name (Legal Business Name): MRS. KAY MARIE WALCHECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W CALUMET ST
APPLETON WI
54915-1462
US

IV. Provider business mailing address

2616 E GATEWOOD DR
APPLETON WI
54915-6650
US

V. Phone/Fax

Practice location:
  • Phone: 920-734-3882
  • Fax: 920-734-4799
Mailing address:
  • Phone: 920-585-1663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11253-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: