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NPI Code Detail

MEDICARE: TERESA LEE LUEBBERING R.PH.

MEDICARE: TERESA LEE LUEBBERING R.PH.
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
1183500000XPharmacist9983-40WI

General Provider Information

NPI Number : 1205440203
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA LEE LUEBBERING R.PH.
Provider Business Mailing Address
First Line : W148N7736 MENOMONEE MANOR DR
Second Line :
City : MENOMONEE FALLS
State : WI
Zip : 53051-7324
Country : US
Telephone Number : 262-232-2598
Fax Number :
Provider Business Practice Location Address
First Line : 5185 S 9TH ST # 1
Second Line :
City : MILWAUKEE
State : WI
Zip : 53221-3627
Country : US
Telephone Number : 800-762-1407
Fax Number : 800-762-9420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2020
Last Update Date : 09/07/2020

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