Provider Demographics
NPI:1619052172
Name:VAXPRO LLC
Entity Type:Organization
Organization Name:VAXPRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PLAVNICK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:414-403-8677
Mailing Address - Street 1:1001 W GLEN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3365
Mailing Address - Country:US
Mailing Address - Phone:414-403-8677
Mailing Address - Fax:262-241-0626
Practice Address - Street 1:1001 W GLEN OAKS LN
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3365
Practice Address - Country:US
Practice Address - Phone:414-403-8677
Practice Address - Fax:262-241-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10629-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty