Provider Demographics
NPI:1336522507
Name:FLEISCHAUER, JORY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JORY
Middle Name:
Last Name:FLEISCHAUER
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 1:550 ALPINE PKWY
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-3817
Mailing Address - Country:US
Mailing Address - Phone:715-220-1405
Mailing Address - Fax:
Practice Address - Street 1:2553 SUN VALLEY DR
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2333
Practice Address - Country:US
Practice Address - Phone:262-646-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17966 - 40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI17966 - 40OtherPHARMACIST