Healthcare Provider Details

I. General information

NPI: 1740533793
Provider Name (Legal Business Name): THOMAS L HOFBAUER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18400 KESTREL TRL
BROOKFIELD WI
53045-6654
US

IV. Provider business mailing address

18400 KESTREL TRL
BROOKFIELD WI
53045-6654
US

V. Phone/Fax

Practice location:
  • Phone: 262-853-7796
  • Fax:
Mailing address:
  • Phone: 262-853-7796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10746-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: