Healthcare Provider Details

I. General information

NPI: 1750658027
Provider Name (Legal Business Name): WILLIAM G OGNACEVIC RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E CAPITOL DR
MILWAUKEE WI
53212-1210
US

IV. Provider business mailing address

404 N 49TH ST
MILWAUKEE WI
53208-3628
US

V. Phone/Fax

Practice location:
  • Phone: 414-964-9851
  • Fax:
Mailing address:
  • Phone: 414-475-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10540-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: