MEDICARE: ERIC FROKE

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	15584-40	WI
2	183500000X	Pharmacist	5724	SD

General Provider Information

NPI Number	:	1053681395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC FROKE

Provider Business Mailing Address
First Line	:	1763 N CAMBRIDGE AVE APT B4
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-1861
Country	:	US
Telephone Number	:	605-670-8946
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 S 27TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-4349
Country	:	US
Telephone Number	:	414-671-3660
Fax Number	:

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

Provider Enumeration Date	:	01/04/2012
Last Update Date	:	01/04/2012

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Directions to “ ERIC FROKE ” Practice Location

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