Healthcare Provider Details

I. General information

NPI: 1629129127
Provider Name (Legal Business Name): MICHAEL PAUL WERNER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 MAIN ST BOX 340
COLFAX WI
54730-9083
US

IV. Provider business mailing address

525 MAIN ST BOX 340
COLFAX WI
54730-9083
US

V. Phone/Fax

Practice location:
  • Phone: 715-962-3784
  • Fax: 715-962-3930
Mailing address:
  • Phone: 715-962-3784
  • Fax: 715-962-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8528-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: