MEDICARE: ADAM JACOB PISTINER PHARM.D

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	3849	NH
2	183500000X	Pharmacist	16969-40	WI

General Provider Information

NPI Number	:	1578817375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM JACOB PISTINER PHARM.D

Provider Business Mailing Address
First Line	:	424 E SILVER SPRING DR
Second Line	:
City	:	WHITEFISH BAY
State	:	WI
Zip	:	53217-5224
Country	:	US
Telephone Number	:	414-332-8380
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 E SILVER SPRING DR
Second Line	:
City	:	WHITEFISH BAY
State	:	WI
Zip	:	53217-5224
Country	:	US
Telephone Number	:	414-332-8380
Fax Number	:

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

Provider Enumeration Date	:	10/31/2012
Last Update Date	:	07/28/2015

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