Provider Demographics
NPI:1518310721
Name:EDELER, NATHAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:EDELER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 OAK AVE N
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2468
Mailing Address - Country:US
Mailing Address - Phone:920-858-0898
Mailing Address - Fax:
Practice Address - Street 1:2415 STATE RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6137
Practice Address - Country:US
Practice Address - Phone:608-788-0803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16860-401835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care