Healthcare Provider Details

I. General information

NPI: 1811851413
Provider Name (Legal Business Name): MARK ROBERT OWENS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15225 W SMALL RD
NEW BERLIN WI
53151-7936
US

IV. Provider business mailing address

15225 W SMALL RD
NEW BERLIN WI
53151-7936
US

V. Phone/Fax

Practice location:
  • Phone: 262-599-7040
  • Fax:
Mailing address:
  • Phone: 262-599-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number13795-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: