Healthcare Provider Details

I. General information

NPI: 1639778046
Provider Name (Legal Business Name): CALLI PLOOSTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALLI CROTTY PHARMD

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 6TH AVE W
MONROE WI
53566-1342
US

IV. Provider business mailing address

300 6TH AVE W
MONROE WI
53566-1342
US

V. Phone/Fax

Practice location:
  • Phone: 608-328-4939
  • Fax:
Mailing address:
  • Phone: 608-328-4939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17464-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: