=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083471981
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANAS ABUZOOR PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2024
-----------------------------------------------------
Last Update Date | 03/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2985 S CHICAGO AVE
-----------------------------------------------------
City | SOUTH MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53172-3133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-762-9653
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2814 N 80TH ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53222-4910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-509-3479
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 22520-40
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------