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General NPI Number Information
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NPI Number | 1285902429
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Entity Type | Individual
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Provider Name | MARY B PISTINER R.PH.
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Gender | Female
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | W62 N190 WASHINGTON AVE WALGREENS
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City | CEDARBURG
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State | WI
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Zip | 53012
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Country | US
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Telephone | 262-375-3039
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Fax | 262-375-2368
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Provider Business Mailing Address
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Address Line | 518 W KENILWORTH CIRCLE
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City | MEQUON
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State | WI
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Zip | 53092
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Country | US
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Telephone | 262-241-8243
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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 | 9760-40
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License Number State | WI
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