Provider Demographics
NPI:1669448742
Name:WISSMANN, CAMILLE KATHERINE (PHARM D)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:KATHERINE
Last Name:WISSMANN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:CAMILLE
Other - Middle Name:JOHNSON
Other - Last Name:WISSMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:923 W WINDTREE DR
Mailing Address - Street 2:923 W WINDTREE DRIVE
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-7222
Mailing Address - Country:US
Mailing Address - Phone:920-268-7251
Mailing Address - Fax:
Practice Address - Street 1:1550 LARIMER ST
Practice Address - Street 2:SUITE 896
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1602
Practice Address - Country:US
Practice Address - Phone:720-336-1530
Practice Address - Fax:888-502-0655
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037824183500000X
ND29988183500000X
IA13629183500000X
CO9984183500000X
WI10702040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist