Provider Demographics
NPI:1376163782
Name:CZECHOWICZ, TABITHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:CZECHOWICZ
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 1:1421 E CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1956
Mailing Address - Country:US
Mailing Address - Phone:414-962-9665
Mailing Address - Fax:
Practice Address - Street 1:1421 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-1956
Practice Address - Country:US
Practice Address - Phone:414-962-9665
Practice Address - Fax:414-962-4590
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17942-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist