Healthcare Provider Details

I. General information

NPI: 1285909077
Provider Name (Legal Business Name): DEBORAH L KESSEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

8231 S 42ND ST
FRANKLIN WI
53132-9380
US

V. Phone/Fax

Practice location:
  • Phone: 414-423-0782
  • Fax:
Mailing address:
  • Phone: 414-423-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number12539-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: