Provider Demographics
NPI:1043497894
Name:SIMON-WOCHINSKI, ELIZABETH M (RPH)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:M
Last Name:SIMON-WOCHINSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:M
Other - Last Name:SIMON-WOCHINSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:N162 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-6171
Mailing Address - Country:US
Mailing Address - Phone:920-731-4830
Mailing Address - Fax:
Practice Address - Street 1:N162 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-6171
Practice Address - Country:US
Practice Address - Phone:920-731-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9603-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist