Healthcare Provider Details

I. General information

NPI: 1841519931
Provider Name (Legal Business Name): JANE PEARL STOIK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST
CORNELL WI
54732-8384
US

IV. Provider business mailing address

PO BOX 554
CORNELL WI
54732-0554
US

V. Phone/Fax

Practice location:
  • Phone: 715-239-6453
  • Fax: 715-239-6078
Mailing address:
  • Phone: 715-239-6453
  • Fax: 715-239-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10170-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: