Provider Demographics
NPI:1770196230
Name:SCHWANDT, MARA ANNE (PHARM D)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:ANNE
Last Name:SCHWANDT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54313-9569
Mailing Address - Country:US
Mailing Address - Phone:920-661-9355
Mailing Address - Fax:920-661-9309
Practice Address - Street 1:464 CARDINAL LN
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:WI
Practice Address - Zip Code:54313-9569
Practice Address - Country:US
Practice Address - Phone:920-661-9355
Practice Address - Fax:920-661-9309
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14406-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI14406-40OtherRETAIL PHARMACY