Provider Demographics
NPI:1194357392
Name:DAVISTER, ALICIA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:DAVISTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:ERDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16823 NACHTWEY RD
Mailing Address - Street 2:
Mailing Address - City:MARIBEL
Mailing Address - State:WI
Mailing Address - Zip Code:54227-9755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:924 N TAYLOR DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4202
Practice Address - Country:US
Practice Address - Phone:920-547-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18448-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist