Healthcare Provider Details

I. General information

NPI: 1518244029
Provider Name (Legal Business Name): ANN BJERKE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 11/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E SUNSET DR
WAUKESHA WI
53189-7603
US

IV. Provider business mailing address

2163 EMPIRE DR
WAUKESHA WI
53186-2637
US

V. Phone/Fax

Practice location:
  • Phone: 262-542-3981
  • Fax:
Mailing address:
  • Phone: 262-549-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10490-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: