Healthcare Provider Details

I. General information

NPI: 1356414361
Provider Name (Legal Business Name): JOSEPH J ZAGOZEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3529 SUPERIOR AVE
SHEBOYGAN WI
53081-1865
US

IV. Provider business mailing address

702 DILLINGHAM AVE
SHEBOYGAN WI
53081-6028
US

V. Phone/Fax

Practice location:
  • Phone: 920-459-2755
  • Fax:
Mailing address:
  • Phone: 920-458-9320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7877
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: