Healthcare Provider Details

I. General information

NPI: 1760304075
Provider Name (Legal Business Name): LEAH LOFQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 SPRING ST
MOUNT PLEASANT WI
53405-1667
US

IV. Provider business mailing address

15012 SPRING ST
UNION GROVE WI
53182-9626
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-4308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23234-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: