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General NPI Number Information
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NPI Number | 1699934802
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Entity Type | Individual
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Provider Name | PAUL KEVIN FERNHOLZ R.PH.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 115 2ND ST
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City | REEDSBURG
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State | WI
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Zip | 53959-1602
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Country | US
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Telephone | 608-524-3215
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Fax | 608-524-8410
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Provider Business Mailing Address
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Address Line | 115 2ND ST P.O. BOX 245
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City | REEDSBURG
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State | WI
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Zip | 53959-1602
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Country | US
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Telephone | 608-524-3215
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Fax | 608-524-8410
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 9451
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License Number State | WI
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