Provider Demographics
NPI:1023459484
Name:PRNRX
Entity type:Organization
Organization Name:PRNRX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:262-784-9600
Mailing Address - Street 1:5478 S WESTRIDGE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-7948
Mailing Address - Country:US
Mailing Address - Phone:262-784-9600
Mailing Address - Fax:262-784-9605
Practice Address - Street 1:5478 S WESTRIDGE DR
Practice Address - Street 2:SUITE B
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7948
Practice Address - Country:US
Practice Address - Phone:262-784-9600
Practice Address - Fax:262-784-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9211-42183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty