MEDICARE: DR. BRIAN WOJCIK PHARMD

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	16913-40	WI
2	183500000X	Pharmacist	16913-40	MT

General Provider Information

NPI Number	:	1689273898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN WOJCIK PHARMD

Provider Business Mailing Address
First Line	:	W277 OLD 29 DR
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54313-9103
Country	:	US
Telephone Number	:	920-676-7874
Fax Number	:

Provider Business Practice Location Address
First Line	:	1244 E GREEN BAY ST
Second Line	:
City	:	SHAWANO
State	:	WI
Zip	:	54166-2208
Country	:	US
Telephone Number	:	715-524-5983
Fax Number	:	715-526-5549

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

Provider Enumeration Date	:	10/19/2020
Last Update Date	:	10/19/2020

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