Individual
GRACE CATHERINE MORTRUDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5000 W NATIONAL AVE, MILWAUKEE, WI 53295-0001
(414) 384-2000
Mailing address
1129 N JACKSON ST APT 617, MILWAUKEE, WI 53202-7100
(401) 864-6813
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5315153295
MI
Other
Enumeration date
07/11/2019
Last updated
07/11/2019
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