Healthcare Provider Details

I. General information

NPI: 1104251982
Provider Name (Legal Business Name): NICHOLAS ZUPEC PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE 7TH FLOOR - INPATIENT PHARMACY
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

3256 ESTATES CT S
SAINT JOSEPH MI
49085-3440
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-5489
  • Fax:
Mailing address:
  • Phone: 847-347-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16857-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: