Basic Information
| Provider Information | |||||||||
| NPI: | 1871847731 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BJERKE | ||||||||
| FirstName: | RONAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 239 CHEROKEE RD | ||||||||
| Address2: | APT 4 | ||||||||
| City: | BEAVER DAM | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539161072 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 705 S UNIVERSITY AVE | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | BEAVER DAM | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539163053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203560040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2012 | ||||||||
| LastUpdateDate: | 10/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 1684840 | WI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.