Provider Demographics
NPI:1750658027
Name:OGNACEVIC, WILLIAM G (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:G
Last Name:OGNACEVIC
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N 49TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3628
Mailing Address - Country:US
Mailing Address - Phone:414-475-1217
Mailing Address - Fax:
Practice Address - Street 1:370 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1210
Practice Address - Country:US
Practice Address - Phone:414-964-9851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10540-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist