Healthcare Provider Details

I. General information

NPI: 1902726151
Provider Name (Legal Business Name): NATALIE MARIE CARLETON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N44W22829 BRIDGE ST
PEWAUKEE WI
53072-2278
US

IV. Provider business mailing address

N44W22829 BRIDGE ST
PEWAUKEE WI
53072-2278
US

V. Phone/Fax

Practice location:
  • Phone: 612-741-0413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15523-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: