Provider Demographics
NPI:1215378518
Name:ANONICH, PAUL J (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:J
Last Name:ANONICH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 W MORELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2963
Mailing Address - Country:US
Mailing Address - Phone:262-542-4488
Mailing Address - Fax:262-650-4040
Practice Address - Street 1:827 W MORELAND BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2963
Practice Address - Country:US
Practice Address - Phone:262-542-4488
Practice Address - Fax:262-650-4040
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11564-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist