Provider Demographics
NPI:1932484078
Name:DORNER, JOHN PAUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:DORNER
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 1:1401 E MASON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3330
Mailing Address - Country:US
Mailing Address - Phone:920-435-7679
Mailing Address - Fax:
Practice Address - Street 1:1401 E MASON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3330
Practice Address - Country:US
Practice Address - Phone:920-435-7679
Practice Address - Fax:920-435-0591
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15181-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist