Healthcare Provider Details

I. General information

NPI: 1851990014
Provider Name (Legal Business Name): NATHAN MAGRUDER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W129N7055 NORTHFIELD DR
MENOMONEE FALLS WI
53051-0538
US

IV. Provider business mailing address

W129N7055 NORTHFIELD DR
MENOMONEE FALLS WI
53051-0538
US

V. Phone/Fax

Practice location:
  • Phone: 262-532-5040
  • Fax:
Mailing address:
  • Phone: 262-532-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17028-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: