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General NPI Number Information
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NPI Number | 1902394570
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Entity Type | Individual
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Provider Name | MICHAEL DENTICE PHARM D.
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Gender | Male
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Dates
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Enumeration Date | 04/28/2018
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Last Update Date | 04/28/2018
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Provider Practice Location Address
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Address Line | 11111 W BURLEIGH ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-3211
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Country | US
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Telephone | 414-290-0910
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Fax |
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Provider Business Mailing Address
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Address Line | N111W16153 CATSKILL LN
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City | GERMANTOWN
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State | WI
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Zip | 53022-4072
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Country | US
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Telephone | 262-327-6018
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 19175-40
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License Number State | WI
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