Healthcare Provider Details

I. General information

NPI: 1881603231
Provider Name (Legal Business Name): RONALD A PERZ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 CARDINAL LN
GREEN BAY WI
54313-9569
US

IV. Provider business mailing address

810 MARYANN LN
GREEN BAY WI
54313-6975
US

V. Phone/Fax

Practice location:
  • Phone: 920-661-9355
  • Fax: 920-661-9309
Mailing address:
  • Phone: 920-360-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9363-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: