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General NPI Number Information
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NPI Number | 1861778821
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Entity Type | Individual
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Provider Name | LOUIS JOHN SOEFKER JR. RPH
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Gender | Male
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Dates
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Enumeration Date | 10/21/2011
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 1300 REDWING DR
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City | OCONOMOWOC
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State | WI
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Zip | 53066-2379
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Country | US
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Telephone | 262-567-4767
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 REDWING DR
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City | OCONOMOWOC
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State | WI
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Zip | 53066-2379
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Country | US
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Telephone | 262-567-4767
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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 | 10135-40
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.031802
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License Number State | IL
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