Provider Demographics
NPI:1083213318
Name:ZWIEG, PAUL KIRK
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:KIRK
Last Name:ZWIEG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E STATE HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-2967
Mailing Address - Country:US
Mailing Address - Phone:715-627-1636
Mailing Address - Fax:715-627-7987
Practice Address - Street 1:200 E STATE HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2967
Practice Address - Country:US
Practice Address - Phone:715-627-1636
Practice Address - Fax:715-627-7987
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10143-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist