Healthcare Provider Details

I. General information

NPI: 1013967991
Provider Name (Legal Business Name): AMY PAT BRIESKE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 S LEONARD ST
WEST SALEM WI
54669-1621
US

IV. Provider business mailing address

535 JOHNSON ST
ONALASKA WI
54650-2068
US

V. Phone/Fax

Practice location:
  • Phone: 608-786-0210
  • Fax: 608-786-0211
Mailing address:
  • Phone: 608-783-5151
  • Fax: 608-786-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12366-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: