Individual
NICHOLAS STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.S. IN PHARMACY
Contact information
Practice address
5851 S PACKARD AVE, CUDAHY, WI 53110-2615
(414) 744-6058
Mailing address
1618 S 115TH CT APT 211, WEST ALLIS, WI 53214-3785
(414) 774-6790
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10632-40
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10632-40
PHARMACIST LICENSE
WI
Enumeration date
11/03/2015
Last updated
11/03/2015
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