Provider Demographics
NPI:1629129127
Name:WERNER, MICHAEL PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PAUL
Last Name:WERNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:525 MAIN ST
Mailing Address - Street 2:BOX 340
Mailing Address - City:COLFAX
Mailing Address - State:WI
Mailing Address - Zip Code:54730-9083
Mailing Address - Country:US
Mailing Address - Phone:715-962-3784
Mailing Address - Fax:715-962-3930
Practice Address - Street 1:525 MAIN ST
Practice Address - Street 2:BOX 340
Practice Address - City:COLFAX
Practice Address - State:WI
Practice Address - Zip Code:54730-9083
Practice Address - Country:US
Practice Address - Phone:715-962-3784
Practice Address - Fax:715-962-3930
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8528-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33170800Medicaid
WI5120073OtherNCPDP
WI33170800Medicaid