Provider Demographics
NPI:1235520784
Name:MITZ, CACEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:CACEY
Middle Name:
Last Name:MITZ
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 1:301 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2620
Mailing Address - Country:US
Mailing Address - Phone:262-375-1628
Mailing Address - Fax:
Practice Address - Street 1:301 FALLS RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-2620
Practice Address - Country:US
Practice Address - Phone:262-375-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16877-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist