Provider Demographics
NPI:1376141333
Name:RAU, DAKOTA TIMOTHY (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:TIMOTHY
Last Name:RAU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 COLOME ST APT E
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-3817
Mailing Address - Country:US
Mailing Address - Phone:715-465-0999
Mailing Address - Fax:
Practice Address - Street 1:2786 COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKE HALLIE
Practice Address - State:WI
Practice Address - Zip Code:54729-5031
Practice Address - Country:US
Practice Address - Phone:715-738-2254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2026640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist