Provider Demographics
NPI:1457361321
Name:BROMBEREK, WENDY M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:M
Last Name:BROMBEREK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-1609
Mailing Address - Country:US
Mailing Address - Phone:715-379-1798
Mailing Address - Fax:
Practice Address - Street 1:1100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1765
Practice Address - Country:US
Practice Address - Phone:175-236-6297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14691-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist