Provider Demographics
NPI:1477807949
Name:WUNROW, DAVID JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOSEPH
Last Name:WUNROW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:ABBOTSFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54405-9647
Mailing Address - Country:US
Mailing Address - Phone:715-223-4494
Mailing Address - Fax:
Practice Address - Street 1:1011 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:ABBOTSFORD
Practice Address - State:WI
Practice Address - Zip Code:54405-9647
Practice Address - Country:US
Practice Address - Phone:715-223-4494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist