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General NPI Number Information
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NPI Number | 1710268842
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Entity Type | Individual
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Provider Name | SCOTT WILLIAM PROCKNOW RPH
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Gender | Male
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 09/02/2011
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Provider Practice Location Address
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Address Line | 704 N MAIN ST
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City | OREGON
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State | WI
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Zip | 53575-1004
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Country | US
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Telephone | 608-835-6771
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Fax | 608-835-0079
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Provider Business Mailing Address
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Address Line | 5248 SNAPDRAGON TRL
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City | FITCHBURG
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State | WI
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Zip | 53711-7642
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Country | US
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Telephone | 608-835-6771
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Fax | 608-835-0079
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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 | 1367340
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License Number State | WI
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