Individual
TANNER PAQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
250 WOLF RUN, MUKWONAGO, WI 53149-8470
(262) 363-8366
Mailing address
250 WOLF RUN, MUKWONAGO, WI 53149-8470
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17123-40
WI
Other
Enumeration date
10/13/2020
Last updated
10/13/2021
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