Provider Demographics
NPI:1881971513
Name:JACHTHUBER, ERIC D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:JACHTHUBER
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:N5776 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WI
Mailing Address - Zip Code:54968-9304
Mailing Address - Country:US
Mailing Address - Phone:920-427-6698
Mailing Address - Fax:
Practice Address - Street 1:25 W. MONTELLO ST
Practice Address - Street 2:
Practice Address - City:MONTELLO
Practice Address - State:WI
Practice Address - Zip Code:53949
Practice Address - Country:US
Practice Address - Phone:608-297-7452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14456-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist