Provider Demographics
NPI:1134557051
Name:GIES, ALISSA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:
Last Name:GIES
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:W1497 COUNTY ROAD V
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-9460
Mailing Address - Country:US
Mailing Address - Phone:920-279-4923
Mailing Address - Fax:
Practice Address - Street 1:N2934 STATE RD 22 NORTH
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982-5267
Practice Address - Country:US
Practice Address - Phone:920-787-5757
Practice Address - Fax:920-787-5382
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17109-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist