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General NPI Number Information
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NPI Number | 1972915148
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Entity Type | Individual
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Provider Name | GEORGE BREITENSTEIN PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 115 N WESTERN AVE
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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 | 715-256-0400
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Fax | 715-256-0402
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Provider Business Mailing Address
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Address Line | 4131 LOVERS LN PO BOX 328
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City | AMHERST
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State | WI
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Zip | 54406-8935
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Country | US
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Telephone | 715-824-7630
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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 | 7640040-40
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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 | PS11868
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License Number State | FL
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