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General NPI Number Information
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NPI Number | 1255924015
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Entity Type | Individual
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Provider Name | ALI ALI
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Gender | Male
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Dates
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Enumeration Date | 02/12/2021
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 1900 W LAYTON AVE APT 212
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City | MILWAUKEE
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State | WI
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Zip | 53221-5320
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Country | US
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Telephone | 216-502-7053
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 N GRANDVIEW BLVD
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City | WAUKESHA
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State | WI
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Zip | 53188-1611
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Country | US
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Telephone | 262-542-2003
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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 | 20042-40
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License Number State | WI
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