Provider Demographics
NPI:1033539796
Name:THIRY, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:THIRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7695 RR AND LTL RD
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:WI
Mailing Address - Zip Code:54205-9754
Mailing Address - Country:US
Mailing Address - Phone:920-837-7510
Mailing Address - Fax:
Practice Address - Street 1:N7695 RR AND LTL RD
Practice Address - Street 2:
Practice Address - City:CASCO
Practice Address - State:WI
Practice Address - Zip Code:54205-9754
Practice Address - Country:US
Practice Address - Phone:920-837-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13515-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist