Provider Demographics
NPI:1487854980
Name:WEITEKAMP, JOHN G (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:G
Last Name:WEITEKAMP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:4366 S MARY ROSS DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-6554
Mailing Address - Country:US
Mailing Address - Phone:414-771-1350
Mailing Address - Fax:414-771-2375
Practice Address - Street 1:7220 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4734
Practice Address - Country:US
Practice Address - Phone:414-771-1350
Practice Address - Fax:414-771-2375
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI10406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist