Provider Demographics
NPI:1902394570
Name:DENTICE, MICHAEL (PHARM D)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DENTICE
Suffix:
Gender:M
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:N111W16153 CATSKILL LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4072
Mailing Address - Country:US
Mailing Address - Phone:262-327-6018
Mailing Address - Fax:
Practice Address - Street 1:11111 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-3211
Practice Address - Country:US
Practice Address - Phone:414-290-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-28
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19175-401835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care