Provider Demographics
NPI:1104451665
Name:SEUBERT, CHAD (PHARMD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:SEUBERT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 E MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-8412
Mailing Address - Country:US
Mailing Address - Phone:608-317-0600
Mailing Address - Fax:
Practice Address - Street 1:240 E HAMPTON RD
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53217-5850
Practice Address - Country:US
Practice Address - Phone:414-962-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18454-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist