Provider Demographics
NPI:1659624831
Name:WARTENWEILER, JAN (RPH)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:WARTENWEILER
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 1:405 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1063
Mailing Address - Country:US
Mailing Address - Phone:608-328-3310
Mailing Address - Fax:608-328-3305
Practice Address - Street 1:405 W 8TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1063
Practice Address - Country:US
Practice Address - Phone:608-328-3310
Practice Address - Fax:608-328-3305
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12733-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist