Provider Demographics
NPI:1194354654
Name:STRAUB, JUSTIN (RPH)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:STRAUB
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 1:2 S BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2624
Mailing Address - Country:US
Mailing Address - Phone:608-628-1656
Mailing Address - Fax:608-251-6209
Practice Address - Street 1:2 S BEDFORD ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2624
Practice Address - Country:US
Practice Address - Phone:608-628-1656
Practice Address - Fax:608-251-6209
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16418-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist