Provider Demographics
NPI:1033509583
Name:NETTESHEIM, DANIEL JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:NETTESHEIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N77W14435 APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4306
Mailing Address - Country:US
Mailing Address - Phone:262-255-8673
Mailing Address - Fax:262-255-8678
Practice Address - Street 1:N77W14435 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-4306
Practice Address - Country:US
Practice Address - Phone:262-255-8673
Practice Address - Fax:262-255-8678
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9785-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist