MEDICARE: MARA ANNE SCHWANDT 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	14406-40	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14406-40	OTHER	WI	RETAIL PHARMACY

General Provider Information

NPI Number	:	1770196230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARA ANNE SCHWANDT PHARM D

Provider Business Mailing Address
First Line	:	464 CARDINAL LN
Second Line	:
City	:	HOWARD
State	:	WI
Zip	:	54313-9569
Country	:	US
Telephone Number	:	920-661-9355
Fax Number	:	920-661-9309

Provider Business Practice Location Address
First Line	:	464 CARDINAL LN
Second Line	:
City	:	HOWARD
State	:	WI
Zip	:	54313-9569
Country	:	US
Telephone Number	:	920-661-9355
Fax Number	:	920-661-9309

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

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/25/2020

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