Healthcare Provider Details

I. General information

NPI: 1891186011
Provider Name (Legal Business Name): FLOYD MAYER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N ROCHESTER ST
MUKWONAGO WI
53149-8738
US

IV. Provider business mailing address

1010 N ROCHESTER ST
MUKWONAGO WI
53149-8738
US

V. Phone/Fax

Practice location:
  • Phone: 262-363-1680
  • Fax: 262-363-1686
Mailing address:
  • Phone: 262-363-1680
  • Fax: 262-363-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10288-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: