Healthcare Provider Details

I. General information

NPI: 1285310243
Provider Name (Legal Business Name): ANDREW ZUEHLKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W MAIN ST
WATERTOWN WI
53094
US

IV. Provider business mailing address

W5818 COUNTY ROAD CW
WATERTOWN WI
53098
US

V. Phone/Fax

Practice location:
  • Phone: 920-206-9588
  • Fax:
Mailing address:
  • Phone: 920-248-9684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22175-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: