Healthcare Provider Details

I. General information

NPI: 1053688366
Provider Name (Legal Business Name): ELISE J ZINN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FALLS RD
GRAFTON WI
53024-2620
US

IV. Provider business mailing address

301 FALLS RD
GRAFTON WI
53024-2620
US

V. Phone/Fax

Practice location:
  • Phone: 262-375-1628
  • Fax:
Mailing address:
  • Phone: 262-375-1628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number16454-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: