Individual
GEORGE BREITENSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
115 N WESTERN AVE, WAUPACA, WI 54981-2201
(715) 256-0400
(715) 256-0402
Mailing address
4131 LOVERS LN, PO BOX 328, AMHERST, WI 54406-8935
(715) 824-7630
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7640040-40
WI
183500000X
Pharmacist
PS11868
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7640040-40
PHARMACY LICENSE NO
WI
Enumeration date
05/22/2014
Last updated
05/22/2014
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