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General NPI Number Information
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NPI Number | 1114203809
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Entity Type | Individual
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Provider Name | LORI SUE PACHEFSKY RPH
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Gender | Female
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 192 N MAIN ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-3462
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Country | US
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Telephone | 920-921-5264
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Fax | 920-921-2760
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Provider Business Mailing Address
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Address Line | 4475 CLUB DR
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City | SLINGER
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State | WI
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Zip | 53086-9720
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Country | US
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Telephone | 262-644-4888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10383
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License Number State | WI
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