Provider Demographics
NPI:1518903889
Name:PIONTEK, MARY-CLARE (RPH)
Entity Type:Individual
Prefix:
First Name:MARY-CLARE
Middle Name:
Last Name:PIONTEK
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 1:122 NOB HILL LANE
Mailing Address - Street 2:
Mailing Address - City:DEPERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115
Mailing Address - Country:US
Mailing Address - Phone:920-337-9638
Mailing Address - Fax:
Practice Address - Street 1:744 SOUTH WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54305-3400
Practice Address - Country:US
Practice Address - Phone:920-431-5696
Practice Address - Fax:920-431-5677
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0009843-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33233700Medicaid
WI33233700Medicaid