Healthcare Provider Details

I. General information

NPI: 1841460615
Provider Name (Legal Business Name): MICHAEL RAABE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S ADAMS ST
NEW LISBON WI
53950-1206
US

IV. Provider business mailing address

112 S ADAMS ST
NEW LISBON WI
53950-1206
US

V. Phone/Fax

Practice location:
  • Phone: 608-562-3302
  • Fax:
Mailing address:
  • Phone: 608-562-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9922-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: