=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871042614
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES KRONENBERG R.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2016
-----------------------------------------------------
Last Update Date | 09/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10150 W NATIONAL AVE STE 150
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53227-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-439-7012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 WEBSTER ST
-----------------------------------------------------
City | BEAVER DAM
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53916-3034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-885-6352
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 10576-40
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------