MEDICARE: PEGGY ANN PROHASKA RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	8107	WI

General Provider Information

NPI Number	:	1013194992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY ANN PROHASKA RPH

Provider Business Mailing Address
First Line	:	138 2ND AVE N
Second Line	:
City	:	PARK FALLS
State	:	WI
Zip	:	54552-1214
Country	:	US
Telephone Number	:	715-762-3283
Fax Number	:	715-762-2980

Provider Business Practice Location Address
First Line	:	138 2ND AVE N
Second Line	:
City	:	PARK FALLS
State	:	WI
Zip	:	54552-1214
Country	:	US
Telephone Number	:	715-762-3283
Fax Number	:	715-762-2980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	01/23/2008

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Directions to “ PEGGY ANN PROHASKA RPH” Practice Location

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