Healthcare Provider Details

I. General information

NPI: 1316453681
Provider Name (Legal Business Name): MICHAEL DEBISSCHOP PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 W WATERTOWN PLANK RD
MILWAUKEE WI
53226-3548
US

IV. Provider business mailing address

N102W17657 STONERIDGE DR
GERMANTOWN WI
53022-6406
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-2853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number18945-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: