Provider Demographics
NPI:1194890749
Name:LOTZER, DONNA M (RPH)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:LOTZER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 MASON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3710
Mailing Address - Country:US
Mailing Address - Phone:608-212-0706
Mailing Address - Fax:
Practice Address - Street 1:2614 MASON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-0001
Practice Address - Country:US
Practice Address - Phone:608-212-0706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8960-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI8960-040OtherPHARMACIST