Provider Demographics
NPI:1982885059
Name:LEVANDOSKI, REBECCA A (RPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:LEVANDOSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15335 W MARK DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5747
Mailing Address - Country:US
Mailing Address - Phone:262-814-0559
Mailing Address - Fax:
Practice Address - Street 1:15335 W MARK DR
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5747
Practice Address - Country:US
Practice Address - Phone:262-814-0559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12712-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist