Healthcare Provider Details

I. General information

NPI: 1356220545
Provider Name (Legal Business Name): AUTUMN MARIE WARD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 08/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 SOUTH AVE
LA CROSSE WI
54601-5429
US

IV. Provider business mailing address

440 2ND AVE N
ONALASKA WI
54650-2505
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-5595
  • Fax:
Mailing address:
  • Phone: 870-919-6402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22814-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: