MEDICARE: DAVID J HOENECKE 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	9292	WI

General Provider Information

NPI Number	:	1659558344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID J HOENECKE RPH

Provider Business Mailing Address
First Line	:	916 E MAIN ST
Second Line	:
City	:	WINNECONNE
State	:	WI
Zip	:	54986-9782
Country	:	US
Telephone Number	:	920-582-4414
Fax Number	:	920-582-7608

Provider Business Practice Location Address
First Line	:	916 E MAIN ST
Second Line	:
City	:	WINNECONNE
State	:	WI
Zip	:	54986-9782
Country	:	US
Telephone Number	:	920-582-4414
Fax Number	:	920-582-7608

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

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	05/25/2010

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