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General NPI Number Information
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NPI Number | 1114337086
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Entity Type | Individual
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Provider Name | JONATHAN CHARLES BADGER PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2014
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 3701 E CALUMET ST
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City | APPLETON
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State | WI
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Zip | 54915-4149
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Country | US
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Telephone | 920-996-0746
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Fax |
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Provider Business Mailing Address
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Address Line | 955 N MUTUAL WAY
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City | APPLETON
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State | WI
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Zip | 54913-8415
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Country | US
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Telephone | 920-954-6400
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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 | 15914-040
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License Number State | WI
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