Healthcare Provider Details

I. General information

NPI: 1790059087
Provider Name (Legal Business Name): NDIDI YAUCHER PHARMD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2012
Last Update Date: 03/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6321 MCKEE RD
FITCHBURG WI
53719-5017
US

IV. Provider business mailing address

431 ACADIA WAY
VERONA WI
53593-8224
US

V. Phone/Fax

Practice location:
  • Phone: 608-819-1523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13193-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: