Provider Demographics
NPI:1811679053
Name:PUSATERI, ANTONIO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:PUSATERI
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 1:256 VINE ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-4735
Mailing Address - Country:US
Mailing Address - Phone:262-707-9907
Mailing Address - Fax:
Practice Address - Street 1:1029 N 14TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3813
Practice Address - Country:US
Practice Address - Phone:920-458-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22270-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist