Provider Demographics
NPI:1083213243
Name:DAUBNER, CARRIE E (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:E
Last Name:DAUBNER
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 1:4165 S VICTORIA CIR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-6148
Mailing Address - Country:US
Mailing Address - Phone:414-465-9169
Mailing Address - Fax:
Practice Address - Street 1:5301 S 76TH ST
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1128
Practice Address - Country:US
Practice Address - Phone:414-978-9019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15158-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist