Healthcare Provider Details

I. General information

NPI: 1548049125
Provider Name (Legal Business Name): PEI-TING HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3649 S HASTINGS WAY
EAU CLAIRE WI
54701-8182
US

IV. Provider business mailing address

3649 S HASTINGS WAY
EAU CLAIRE WI
54701-8182
US

V. Phone/Fax

Practice location:
  • Phone: 715-838-0447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22328-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: