Healthcare Provider Details

I. General information

NPI: 1881140366
Provider Name (Legal Business Name): JEREL SEHLOFF RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WESTERN AVE
MANITOWOC WI
54220-3712
US

IV. Provider business mailing address

2300 WESTERN AVE
MANITOWOC WI
54220-3712
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-2273
  • Fax: 920-320-5103
Mailing address:
  • Phone: 920-320-2273
  • Fax: 920-320-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8598-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: