Provider Demographics
NPI:1912569476
Name:GUETZLAFF, ERICA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:GUETZLAFF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 PRAIRIE GRASS RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-3827
Mailing Address - Country:US
Mailing Address - Phone:608-395-4503
Mailing Address - Fax:
Practice Address - Street 1:5510 RESEARCH PARK DR STE 150
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5380
Practice Address - Country:US
Practice Address - Phone:608-204-7739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14905-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty