Healthcare Provider Details

I. General information

NPI: 1508465758
Provider Name (Legal Business Name): HENRY L ESKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W190N9855 APPLETON AVE
GERMANTOWN WI
53022-4504
US

IV. Provider business mailing address

W190N9855 APPLETON AVE
GERMANTOWN WI
53022-4504
US

V. Phone/Fax

Practice location:
  • Phone: 262-255-5351
  • Fax:
Mailing address:
  • Phone: 262-255-5351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10305-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: