Provider Demographics
NPI:1508882242
Name:FETZER, SANDRA JANE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JANE
Last Name:FETZER
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:N41W33475 NASHOTAH RD
Mailing Address - Street 2:
Mailing Address - City:NASHOTAH
Mailing Address - State:WI
Mailing Address - Zip Code:53058-9504
Mailing Address - Country:US
Mailing Address - Phone:262-367-8900
Mailing Address - Fax:
Practice Address - Street 1:ZABLOCKI DEPARTMENT OF VETERANS AFFAIRS MEDICAL CTR
Practice Address - Street 2:5000 WEST NATIONAL AVE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:414-389-4276
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist