Provider Demographics
NPI:1568061745
Name:SOBCZAK, DANIEL JOHN (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:SOBCZAK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 TRAMORE TRL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1087
Mailing Address - Country:US
Mailing Address - Phone:608-334-3806
Mailing Address - Fax:
Practice Address - Street 1:2950 NEW PINERY RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-9225
Practice Address - Country:US
Practice Address - Phone:608-742-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11038-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist