Provider Demographics
NPI:1770850463
Name:THIELKE, TRIGG N (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRIGG
Middle Name:N
Last Name:THIELKE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N994 HULTMAN RD
Mailing Address - Street 2:
Mailing Address - City:OGEMA
Mailing Address - State:WI
Mailing Address - Zip Code:54459
Mailing Address - Country:US
Mailing Address - Phone:715-767-5213
Mailing Address - Fax:
Practice Address - Street 1:N994 HULTMAN RD
Practice Address - Street 2:
Practice Address - City:OGEMA
Practice Address - State:WI
Practice Address - Zip Code:54459-0000
Practice Address - Country:US
Practice Address - Phone:715-767-5213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14498-40183500000X
CA60786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist