Provider Demographics
NPI:1598087926
Name:VANDEHEY, PATRICIA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:VANDEHEY
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 1:801 N ROCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1142
Mailing Address - Country:US
Mailing Address - Phone:262-363-4001
Mailing Address - Fax:262-363-5699
Practice Address - Street 1:801 N ROCHESTER ST
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1142
Practice Address - Country:US
Practice Address - Phone:262-363-4001
Practice Address - Fax:262-363-5699
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112496183500000X
WI9494-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33104700Medicaid
WI33104700Medicaid