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General NPI Number Information
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NPI Number | 1669755856
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Entity Type | Individual
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Provider Name | SCOTT BARYENBRUCH
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Gender | Male
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 717 8TH AVE
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City | MONROE
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State | WI
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Zip | 53566-4000
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Country | US
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Telephone | 608-325-7020
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Fax | 608-325-7026
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Provider Business Mailing Address
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Address Line | 302 DOUGLAS CT
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City | BARNEVELD
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State | WI
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Zip | 53507-9414
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Country | US
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Telephone | 608-386-4041
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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 | 14119
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License Number State | WI
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