Healthcare Provider Details

I. General information

NPI: 1750576021
Provider Name (Legal Business Name): CHRISTINE B MASLONKOWSKI RPH, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 E RIDGE CTR
EAU CLAIRE WI
54701-3410
US

IV. Provider business mailing address

2240 E RIDGE CTR
EAU CLAIRE WI
54701-3410
US

V. Phone/Fax

Practice location:
  • Phone: 715-858-7008
  • Fax: 715-838-2910
Mailing address:
  • Phone: 715-858-7008
  • Fax: 715-838-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number12034040
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number113308
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: