Healthcare Provider Details

I. General information

NPI: 1942267471
Provider Name (Legal Business Name): JOANNE MARIE NARUT PHARM.D. R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SHARP RD
WATERFORD WI
53185-5214
US

IV. Provider business mailing address

1018 GENEVA ST
LAKE GENEVA WI
53147-1702
US

V. Phone/Fax

Practice location:
  • Phone: 262-534-8540
  • Fax: 262-534-8576
Mailing address:
  • Phone: 262-903-4130
  • Fax: 262-534-8576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9696-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: