Provider Demographics
NPI:1558605303
Name:DOW, ELIZABETH NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:DOW
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 1:16385 GEORGETOWN DR
Mailing Address - Street 2:APT 210
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5795
Mailing Address - Country:US
Mailing Address - Phone:906-370-7755
Mailing Address - Fax:
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-2690
Practice Address - Fax:414-805-2626
Is Sole Proprietor?:No
Enumeration Date:2012-11-18
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16657-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist