Provider Demographics
NPI:1043550999
Name:CALAWERTS, VICKY LYN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:LYN
Last Name:CALAWERTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1147
Mailing Address - Country:US
Mailing Address - Phone:715-341-6102
Mailing Address - Fax:715-254-0016
Practice Address - Street 1:1600 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1147
Practice Address - Country:US
Practice Address - Phone:715-341-6102
Practice Address - Fax:715-254-0016
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12689-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist