Provider Demographics
NPI:1013967991
Name:BRIESKE, AMY PAT (RPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:PAT
Last Name:BRIESKE
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 1:535 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2068
Mailing Address - Country:US
Mailing Address - Phone:608-783-5151
Mailing Address - Fax:608-786-0211
Practice Address - Street 1:126 S LEONARD ST
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-1621
Practice Address - Country:US
Practice Address - Phone:608-786-0210
Practice Address - Fax:608-786-0211
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12366-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12366-040OtherPHARMACY LICENSE