Provider Demographics
NPI:1861818775
Name:MAILE, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MAILE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SERVICE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-1297
Mailing Address - Country:US
Mailing Address - Phone:920-894-4370
Mailing Address - Fax:
Practice Address - Street 1:1001 SERVICE RD STE 101
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042-1297
Practice Address - Country:US
Practice Address - Phone:920-894-4370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-16
Last Update Date:2014-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist