Provider Demographics
NPI:1104194075
Name:NEVERMANN, JAMES PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PAUL
Last Name:NEVERMANN
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 1:423 MERTON AVE.
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1506
Mailing Address - Country:US
Mailing Address - Phone:262-367-4951
Mailing Address - Fax:262-367-4905
Practice Address - Street 1:423 MERTON AVE
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-1506
Practice Address - Country:US
Practice Address - Phone:262-367-4751
Practice Address - Fax:262-367-4905
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist