Provider Demographics
NPI:1275544967
Name:WITZANY, CHRISTOPHER JOHN (R PH)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:WITZANY
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:GRANTSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:54840-0039
Mailing Address - Country:US
Mailing Address - Phone:715-463-2525
Mailing Address - Fax:715-463-5343
Practice Address - Street 1:122 W. MADISON AVE.
Practice Address - Street 2:
Practice Address - City:GRANTSBURG
Practice Address - State:WI
Practice Address - Zip Code:54840
Practice Address - Country:US
Practice Address - Phone:715-463-2525
Practice Address - Fax:715-463-5343
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11045-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist