Healthcare Provider Details

I. General information

NPI: 1700217478
Provider Name (Legal Business Name): ASHLEY MEDINGER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE OUTPATIENT PHARMACY
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

2900 W OKLAHOMA AVE OUTPATIENT PHARMACY
MILWAUKEE WI
53215-4330
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6930
  • Fax: 414-649-5367
Mailing address:
  • Phone: 414-649-6930
  • Fax: 414-649-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16444-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: