Provider Demographics
NPI:1013291004
Name:BIRGIOLIENE, AUDRONE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:AUDRONE
Middle Name:
Last Name:BIRGIOLIENE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 DURAND AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-4424
Mailing Address - Country:US
Mailing Address - Phone:262-554-8686
Mailing Address - Fax:262-554-0744
Practice Address - Street 1:3825 DURAND AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-4424
Practice Address - Country:US
Practice Address - Phone:262-554-8686
Practice Address - Fax:262-554-0744
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14603-40183500000X
IL051-293247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist