Healthcare Provider Details

I. General information

NPI: 1245456870
Provider Name (Legal Business Name): MAUREEN MARIE GRICHAR R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE SUITE 200 W
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

6670 W ROBINWOOD LN
FRANKLIN WI
53132-9270
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-5117
  • Fax:
Mailing address:
  • Phone: 414-425-5367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8556
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: