Provider Demographics
NPI:1134717010
Name:STOLZE, AUSTIN JAMES (PHARMD)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JAMES
Last Name:STOLZE
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 1:1042 ERIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1844
Mailing Address - Country:US
Mailing Address - Phone:715-212-2654
Mailing Address - Fax:
Practice Address - Street 1:2920 FITCHRONA RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-1802
Practice Address - Country:US
Practice Address - Phone:608-273-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20514-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist