Individual
ERNEST THEODORE WITZKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.S., M.S.
Contact information
Practice address
300 N MAIN ST, FORT ATKINSON, WI 53538-1831
(920) 563-7658
Mailing address
300 N MAIN ST, FORT ATKINSON, WI 53538-1831
(920) 563-7658
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7962
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7962
PHARMACIST LICENSE
WI
Enumeration date
11/03/2011
Last updated
11/03/2011
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