Provider Demographics
NPI:1447537360
Name:LITZENBERG, JOHN RANDALL (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RANDALL
Last Name:LITZENBERG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2836
Mailing Address - Country:US
Mailing Address - Phone:414-476-5585
Mailing Address - Fax:414-476-0892
Practice Address - Street 1:6600 W STATE ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2836
Practice Address - Country:US
Practice Address - Phone:414-476-5585
Practice Address - Fax:414-476-0892
Is Sole Proprietor?:No
Enumeration Date:2011-11-06
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist