Healthcare Provider Details

I. General information

NPI: 1841236304
Provider Name (Legal Business Name): DAN FITZGERALD PHARMACY,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 E SILVER SPRING DR
WHITEFISH BAY WI
53217-5224
US

IV. Provider business mailing address

424 E SILVER SPRING DR
WHITEFISH BAY WI
53217-5224
US

V. Phone/Fax

Practice location:
  • Phone: 414-332-8380
  • Fax: 414-332-3798
Mailing address:
  • Phone: 414-332-8380
  • Fax: 414-332-3798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9716
License Number StateWI

VIII. Authorized Official

Name: MICHAEL D PISTINER
Title or Position: OWNER
Credential: R.PH.
Phone: 414-332-8380