Provider Demographics
NPI:1245331990
Name:SOBCZAK, VICTORIA LEE (RPH)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LEE
Last Name:SOBCZAK
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 1:620 OVERLOOK TER
Mailing Address - Street 2:
Mailing Address - City:DE FOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-3046
Mailing Address - Country:US
Mailing Address - Phone:608-846-2920
Mailing Address - Fax:
Practice Address - Street 1:645 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DE FOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1421
Practice Address - Country:US
Practice Address - Phone:608-846-4736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11196-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist