Provider Demographics
NPI:1366443749
Name:BESCHTA, LAURA JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:BESCHTA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5185 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-3627
Mailing Address - Country:US
Mailing Address - Phone:414-486-3100
Mailing Address - Fax:414-486-3120
Practice Address - Street 1:5185 S 9TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-3627
Practice Address - Country:US
Practice Address - Phone:414-486-3100
Practice Address - Fax:414-486-3120
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13116-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist