Healthcare Provider Details

I. General information

NPI: 1477750420
Provider Name (Legal Business Name): BRENDA DIANNE STRAWN R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WASHINGTON ST
TWO RIVERS WI
54241-3045
US

IV. Provider business mailing address

4019 N RUDELLA RD
MEQUON WI
53092-2794
US

V. Phone/Fax

Practice location:
  • Phone: 920-794-1225
  • Fax: 920-794-7091
Mailing address:
  • Phone: 262-242-1922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10194040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: