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General NPI Number Information
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NPI Number | 1265579395
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Entity Type | Individual
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Provider Name | MR. GREGORY DOCKTER
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2909 E WASHINGTON AVE
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City | MADISON
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State | WI
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Zip | 53704-5142
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Country | US
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Telephone | 608-244-1301
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 STARLIGHT LN
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City | COTTAGE GROVE
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State | WI
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Zip | 53527-9137
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Country | US
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Telephone |
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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 | 12155-040
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License Number State | WI
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