Individual
JO ELLEN LUSARDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1401 E MASON ST, GREEN BAY, WI 54301-3330
(920) 435-7679
(920) 435-0591
Mailing address
1401 E MASON ST, GREEN BAY, WI 54301-3330
(920) 435-7679
(920) 435-0591
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12476-40
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12476-040
REGISTERED PHARMACIST
WI
01
—
5302027002
REGISTERED PHARMACIST
MI
Enumeration date
10/20/2011
Last updated
10/20/2011
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