Provider Demographics
NPI:1477687630
Name:WOZNIAK, CHERYL L (RPH)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:WOZNIAK
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 1:2987 FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-1379
Mailing Address - Country:US
Mailing Address - Phone:920-405-9006
Mailing Address - Fax:
Practice Address - Street 1:1881 CHICAGO ST
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-3770
Practice Address - Country:US
Practice Address - Phone:920-403-8050
Practice Address - Fax:920-403-8206
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist