Basic Information
| Provider Information | |||||||||
| NPI: | 1770927584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MISKULIN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.PH. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1008 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OCONTO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541531538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208344455 | ||||||||
| FaxNumber: | 9208343655 | ||||||||
| Practice Location | |||||||||
| Address1: | 1008 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OCONTO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541531538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208344455 | ||||||||
| FaxNumber: | 9208343655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2013 | ||||||||
| LastUpdateDate: | 04/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 12177-40 | WI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.