Healthcare Provider Details

I. General information

NPI: 1629903836
Provider Name (Legal Business Name): SUSAN WHEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 GRAND AVE
MANITOWOC WI
54220-6351
US

IV. Provider business mailing address

2415 GRAND AVE
MANITOWOC WI
54220-6351
US

V. Phone/Fax

Practice location:
  • Phone: 920-912-2211
  • Fax:
Mailing address:
  • Phone: 920-912-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11511-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: