Provider Demographics
NPI:1275605685
Name:PATZER, JACK L (BS RPH)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:L
Last Name:PATZER
Suffix:
Gender:M
Credentials:BS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 N FARWELL AVE
Mailing Address - Street 2:UNIT #210
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1571
Mailing Address - Country:US
Mailing Address - Phone:414-520-8981
Mailing Address - Fax:
Practice Address - Street 1:13700 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-9521
Practice Address - Country:US
Practice Address - Phone:262-797-4610
Practice Address - Fax:262-797-4615
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8105-0401835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric