Healthcare Provider Details

I. General information

NPI: 1194631267
Provider Name (Legal Business Name): ALTHERESE QUINGUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6204 W SILVER SPRING DR STE D
MILWAUKEE WI
53218-3137
US

IV. Provider business mailing address

2054 S 102ND ST APT 328
WEST ALLIS WI
53227-1339
US

V. Phone/Fax

Practice location:
  • Phone: 414-999-6464
  • Fax: 414-250-0034
Mailing address:
  • Phone: 414-739-0967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23004-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: