Provider Demographics
NPI:1811067754
Name:AXT, DAVID (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:AXT
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:W12802 COUNTY HIGHWAY A
Mailing Address - Street 2:
Mailing Address - City:BOWLER
Mailing Address - State:WI
Mailing Address - Zip Code:54416-0086
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W12802 COUNTY HIGHWAY A
Practice Address - Street 2:
Practice Address - City:BOWLER
Practice Address - State:WI
Practice Address - Zip Code:54416-0086
Practice Address - Country:US
Practice Address - Phone:715-793-5074
Practice Address - Fax:715-793-5074
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10049-0401835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy