Healthcare Provider Details

I. General information

NPI: 1588838502
Provider Name (Legal Business Name): MICHAEL JOSEPH PELSOH PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RICHLAND HOSPITAL 333 E 2ND ST
RICHLAND CENTER WI
53581
US

IV. Provider business mailing address

27730 CRESTVIEW DR
RICHLAND CENTER WI
53581-8788
US

V. Phone/Fax

Practice location:
  • Phone: 608-647-6321
  • Fax:
Mailing address:
  • Phone: 608-647-5845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9587
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: