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NPI Code Detail

MEDICARE: MR. JEROME A PRUSS RPH

MEDICARE: MR. JEROME A PRUSS 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
1183500000XPharmacistRP 033110 LPA
2183500000XPharmacist12132-040WI

General Provider Information

NPI Number : 1912921859
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEROME A PRUSS RPH
Provider Business Mailing Address
First Line : 3116 N OAKDALE LN
Second Line :
City : APPLETON
State : WI
Zip : 54914-6875
Country : US
Telephone Number : 920-735-1605
Fax Number :
Provider Business Practice Location Address
First Line : ZABLOCKI DEPARTMENT OF VETERAN AFFAIRS MEDICAL CTR
Second Line : 500 WEST NATIONAL AVENUE
City : MILWAUKEE
State : WI
Zip : 53295-0001
Country : US
Telephone Number : 414-384-2000
Fax Number : 414-389-4276
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 07/08/2007

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