Provider Demographics
NPI:1861814253
Name:MITTELSTAEDT, SETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:MITTELSTAEDT
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 1:1100 E RIVERVIEW EXPY
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-5483
Mailing Address - Country:US
Mailing Address - Phone:715-421-1750
Mailing Address - Fax:715-421-1168
Practice Address - Street 1:1100 E RIVERVIEW EXPY
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-5483
Practice Address - Country:US
Practice Address - Phone:715-421-1750
Practice Address - Fax:715-421-1168
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16301-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist