Healthcare Provider Details

I. General information

NPI: 1417224189
Provider Name (Legal Business Name): ANNAMARIE KUCERA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2011
Last Update Date: 11/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 MILWAUKEE AVE
BURLINGTON WI
53105-1346
US

IV. Provider business mailing address

1257 PEREGRINE CT
BURLINGTON WI
53105-2422
US

V. Phone/Fax

Practice location:
  • Phone: 262-767-0697
  • Fax:
Mailing address:
  • Phone: 262-661-4331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14610-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: