Provider Demographics
NPI:1003264227
Name:OBERSCHLAKE, MAGDALENA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MAGDALENA
Middle Name:
Last Name:OBERSCHLAKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13995 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4524
Mailing Address - Country:US
Mailing Address - Phone:262-827-0201
Mailing Address - Fax:
Practice Address - Street 1:13995 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4524
Practice Address - Country:US
Practice Address - Phone:262-827-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17833-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist