Individual
DR. JESSICA BETH MICHAUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D., BCPS
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-6575
Mailing address
1857 N 73RD ST, WAUWATOSA, WI 53213-2254
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
051.289448
IL
1835P1200X
Pharmacotherapy Pharmacist
Primary
16578-40
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03-1-24675
OH STATE LICENSE
OH
01
—
051.289448
IL STATE LICENSE
IL
01
—
16578-40
WI LICENSE
WI
Enumeration date
12/04/2006
Last updated
11/21/2012
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