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General NPI Number Information
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NPI Number | 1518310721
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Entity Type | Individual
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Provider Name | NATHAN EDELER PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 2415 STATE RD
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City | LA CROSSE
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State | WI
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Zip | 54601-6137
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Country | US
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Telephone | 608-788-0803
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Fax |
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Provider Business Mailing Address
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Address Line | 843 OAK AVE N
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City | ONALASKA
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State | WI
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Zip | 54650-2468
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Country | US
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Telephone | 920-858-0898
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 16860-40
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License Number State | WI
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