Provider Demographics
NPI:1891186011
Name:MAYER, FLOYD
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:
Last Name:MAYER
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 1:1010 N ROCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-8738
Mailing Address - Country:US
Mailing Address - Phone:262-363-1680
Mailing Address - Fax:262-363-1686
Practice Address - Street 1:1010 N ROCHESTER ST
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-8738
Practice Address - Country:US
Practice Address - Phone:262-363-1680
Practice Address - Fax:262-363-1686
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10288-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist