Healthcare Provider Details

I. General information

NPI: 1922918432
Provider Name (Legal Business Name): SELMA GOETZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 S 16TH ST
MILWAUKEE WI
53215-4526
US

IV. Provider business mailing address

N77W6825 PINE ST
CEDARBURG WI
53012-3301
US

V. Phone/Fax

Practice location:
  • Phone: 414-647-5027
  • Fax:
Mailing address:
  • Phone: 414-647-5027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14514-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: