Provider Demographics
NPI:1912330374
Name:NAMOWICZ, CASSANDRA MARIE (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:MARIE
Last Name:NAMOWICZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4220
Mailing Address - Country:US
Mailing Address - Phone:262-635-0181
Mailing Address - Fax:262-635-1865
Practice Address - Street 1:4810 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4220
Practice Address - Country:US
Practice Address - Phone:262-365-0181
Practice Address - Fax:262-635-1865
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17178-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist