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General NPI Number Information
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NPI Number | 1760698542
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHARMACY ASSOCIATES
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 105 N WESTERN AVE STE 3
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City | WAUPACA
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State | WI
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Zip | 54981-2201
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Country | US
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Telephone | 715-245-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 105 N WESTERN AVE STE 3
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City | WAUPACA
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State | WI
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Zip | 54981-2201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. MATTHEW SANGER
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Credential |
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Telephone | 715-256-2880
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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 | 11837
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License Number State | WI
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